GI EMERGENCIES · MEMBERSHIP SURGERY

Perforated peptic ulcer — 48M NSAID user, sudden pain

12 decision points ~22 min Difficulty 3/5 Membership

Setting

You are the surgical registrar on-call at Korle Bu. Theatre + anaesthesia are activated on request; laparoscopic equipment is available; blood-bank and antibiotic pharmacy are on standby.

Patient

Mr M, a 48-year-old accountant, presents 6 hours after sudden onset of severe epigastric pain that then became generalised. He has been taking daily ibuprofen for back pain and drinks socially. He is toxic-appearing: BP 108/68, HR 118, temp 37.9, RR 26. Abdomen: board-like rigidity, absent bowel sounds, generalised guarding + rebound tenderness. PR unremarkable. No previous surgery.

Reference stack

Bailey & Love 28e Ch 65 · Sabiston 21e Ch 46 · WSES 2020 perforated peptic ulcer · Boey 1982 · Graham 1937

Start cascade →

You'll be asked to decide what happens next at each step. There's no timer — take your time. The correct answer + evidence-anchored rationale is revealed after each choice.