Double Gastric Perforation - A Surgical Enigma

Objective: Double gastric perforations are a rare surgical entity and the operating surgeon has to be aware of the possibiity of multiple perforations. When the perforation is involving the stomach malignancy has to be ruled out. With the advent of Proton Pump Inhibitors and H.pylori treatment therapy most of the peptic ulcers are managed without the need of a surgical intervention, yet the complications such as perforation and protracted bleeding warrant an emergency surgical intervention.

Here in we report a case of a 70year old male with double gastric perforation.

Presentation of Case: A 70 year old male patient presented to casuality with complaints of pain abdomen since 3 days and not passing stool and flatus since 2 days. Initial vitals were heart rate 104beats/min, respiratory rate 23/min bp 95/65mmhg.

Initial resuscitation was done. Chest x-ray and x-ray erect abdomen and usg abdomen and pelvis revealed Gas under the diaphragm Usg revealed- peritoneal collection with air echoes and debris (Hollow viscous perforation?).

Discussion: Patient was taken up for emergency laparotomy and intra op pathology revelaed 2 perforations one in the antrum and one in pylorus of stomach.

Biopsy was taken and modified grahams omental patch repair done. Patient discharged without any issue and ugie after 6weeks revealed no evidence of malignancy.

Conclusion: The occurance of multile perforations is rare and should always be kept in mind when encountering a Hollow Viscous Perforation. In emergency setting a quick and a safe surgery has to be carried out with thorough peritoneal toilting followed by postoperative medical management of H. pylori infection.