Prompt diagnosis of gastroduodenal perforation requires
a high index of suspicion based on history and clinical
examination. A history of intermittent abdominal pain or
gastroesophageal reflux is common. Additionally, known
peptic ulcer disease that has been inadequately treated
or with ongoing symptoms and sudden exacerbation of
pain can be suspicious for perforation. A history of recent
trauma or instrumentation followed by abdominal pain
and tenderness should alert the clinician to the potential
for injury. Patients with gastroduodenal perforation