穿孔性消化性溃疡,虽然相对罕见,代表严重的外科紧急情况,可能危及生命。它们的意义不仅在于它们的急性表现,还在于它们带来的诊断挑战,特别是有复杂病史的患者。这里我们介绍一个71岁的女性,有复杂的病史,包括胰岛素依赖型2型糖尿病,高血压,高脂血症,甲状腺功能减退,痴呆症,憩室炎,和慢性背痛,他们最初反应迟钝,发紫。尽管由于她的医疗复杂性和阿片类药物的使用而在诊断方面面临挑战,她最终被诊断为十二指肠溃疡穿孔。可悲的是,尽管立即进行了手术干预,她屈服于疾病,强调管理消化性溃疡穿孔的复杂性,尤其是患有多种慢性疾病的患者。消化性溃疡(PUD)通常可以保持无症状,导致诊断延迟和穿孔等潜在危及生命的并发症。与穿孔性消化性溃疡相关的死亡率差异很大,从1.3%到20%不等,风险因素包括非甾体抗炎药(NSAID)的使用,幽门螺杆菌感染,吸烟,和皮质类固醇的使用。诊断需要高度怀疑,彻底的临床检查,和成像模式,如计算机断层扫描(CT)扫描与口腔对比。治疗策略从静脉(IV)组胺H2受体阻滞剂或质子泵抑制剂(PPI)的非手术治疗到手术干预,取决于患者的血液动力学稳定性。然而,该病例强调了及时诊断和干预的挑战,特别是在有复杂病史的患者中,症状可能被掩盖或归因于其他合并症。最近的研究表明,人口结构向老年转变,女性患病率更高,强调提高医疗保健提供者的意识和警惕的重要性。早期识别症状,迅速调查,和跨学科合作对于优化出现穿孔性消化性溃疡的患者的预后至关重要,特别是在他们潜在的医疗条件下。
Perforated peptic ulcers, though relatively rare, represent critical surgical emergencies with potentially life-threatening consequences. Their significance lies not only in their acute presentation but also in the diagnostic challenges they pose, particularly in patients with complex medical histories. Here we present a case of a 71-year-old female with a complex medical history, including insulin-dependent type 2 diabetes mellitus, hypertension, hyperlipidemia, hypothyroidism, dementia, diverticulitis, and chronic back pain, who initially were unresponsive and cyanotic. Despite challenges in diagnosis due to her medical complexity and opioid use, she was ultimately diagnosed with a perforated duodenal ulcer. Tragically, despite immediate surgical intervention, she succumbed to her illness, highlighting the complexities involved in managing perforated peptic ulcers, especially in patients with multiple chronic medical conditions. Peptic ulcer disease (PUD) can often remain asymptomatic, leading to delayed diagnosis and potentially life-threatening complications like perforation. Mortality rates associated with perforated peptic ulcers vary widely, ranging from 1.3% to 20%, with risk factors including nonsteroidal anti-inflammatory drug (NSAID) use, Helicobacter pylori infection, smoking, and corticosteroid use. Diagnosis necessitates a high index of suspicion, thorough clinical examination, and imaging modalities such as computed tomography (CT) scans with oral contrast. Treatment strategies range from nonoperative management with intravenous (IV) histamine H2-receptor blockers or proton pump inhibitors (PPIs) to surgical intervention, depending on the patient\'s hemodynamic stability. However, the case presented underscores the challenges in timely diagnosis and intervention, particularly in patients with complex medical histories, where symptoms may be masked or attributed to other comorbidities. Recent studies indicate a demographic shift toward older age and a higher prevalence among females, emphasizing the importance of increased awareness and vigilance among healthcare providers. Early recognition of symptoms, prompt investigation, and interdisciplinary collaboration are crucial in optimizing outcomes for patients presenting with perforated peptic ulcers, especially in the context of their underlying medical conditions.