Perforated duodenal ulcerA 61-year old woman with a 12 hour history of sudden onset of pain in the left iliac fossa (LIF). She gave a 12-month history of LIF and pelvic pain, which she attributed to uterine myomata. She had been on an NSAID for two years. She had LIF peritonitis and the rest of the abdomen was soft.
At operation there was pus in the pelvis and LIF. The source of the pus was a perforated duodenal ulcer. The photograph shows the punched-out ulcer with slough around the area of peritoneal contamination, suggesting the the leak had initially been confined.
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