Perforated gastrointestinal ulcers presenting as acute respiratory distress

Abstract

Background: Dyspnea is one of the most common complaints facing the emergency medicine physician. Some of the gastrointestinal causes of dyspnea are self-limited and not life-threatening, yet others are, and early diagnosis and treatment are crucial.

Methods: In this article we presented one of these life-threatening conditions through a clinical description of a patient presenting with acute respiratory distress that was finally diagnosed to be the result of a perforated gastric ulcer.

Results: An emergent thoracotomy revealed a small ulcer with perforation in the fundus of the stomach. The patient was transferred after the operation to the intensive care unit and after a prolonged hospitalization discharged home. Biopsies taken from the ulcer showed diffuse inflammation, with no evidence of microorganisms or malignancy.

Conclusion: Perforation of gastric and duodenal ulcers is a rare yet existing cause of dyspnea and respiratory failure and should be kept in mind by the emergency physician, especially when other more common causes are ruled out.

Keywords: Dyspnea; Gastric and duodenal ulcers; Perforation.

Figure 1

Chest X-ray of the patient demonstrated severe kyphoscoliosis and unspecific opacity.

Figure 2

Chest CT scan showed the stomach above the diaphragm, found whole in the thoracic cavity, and also demonstrated the pneumomediastinum, subcutaneous emphysema.