Surgery
Perforated Viscus & Pneumoperitoneum
Surgery

Perforated Viscus & Pneumoperitoneum

Surgical catastrophe — board-like abdomen → free air → laparotomy.

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◆Presentation

  • •Sudden severe pain → rigid board-like abdomen + rebound tenderness
  • •Most often from NSAID-induced peptic ulcer perforation

◆Triage imaging

  • •Upright CXR first → free air under diaphragm
  • •AVOID CT if free air already visible — delays definitive care

◆Management

  • •Free air + acute abdomen = emergent ex-lap
  • •IV fluids + broad-spectrum antibiotics + PPI

High-yield pearls

  • ◆NSAID PUD → most common perforation
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