Undiagnosed perforation of silent duodenal ulcer: A case report with review

This is a case report where one Malaysian Indian female in her early fifties died due to perforation of duodenal ulcer. She was apparently well before and had attended hospital for minor complaint of gastritis on the evening before her death. GIT perforation is an acute emergency, if diagnosis is missed then it adversely affect the life of the patient. The treatment of perforation and peritonitis is very time consuming and costly, and at times results in severe infection, peritonitis, adhesions, and shock. In some cases, even sudden death do occur in few hours after perforation. In this case, patient died within hour of acute symptoms due to shock. Fatality following peptic ulcer perforation usually takes variable time, which can range from few hours to many days or week.

Peptic ulcer disease is more aggressive in menopausal women. In peptic ulcer co-morbidity factors, mainly infection due to Helicobacter pylori and the regular intake of non- steroidal anti-inflammatory drugs have been identified as major risk factors. On postmortem examination, one fresh perforated duodenal ulcer was found in anterior part of duodenum. Peritoneal cavity was full with stomach and GIT contents. There were findings of chemical peritonitis and shock thereof. In this case, issue of negligence was raised. All related issues of missed diagnosis, negligence, or judgmental error are discussed. The raised medico-legal issues are addressed in question and answer form.