Five diagnostic indicators, including three signs and symptoms
of PUP (intense abdominal pain, tenderness, and
guarding) were significantly different from peptic ulcer
patients with no perforation. In the literature,2 it is suggested
that gastrointestinal perforation often leads to catastrophic
consequences.
Erosion of the gastrointestinal wall by the
ulcer leads to spillage of stomach or intestinal content into
the abdominal cavity. Perforation at the anterior surface of the
stomach leads to the first sign which is often sudden intense
abdominal pain. Posterior wall perforation leads to tenderness
and guarding, which often radiates pain to the back.
A plain abdominal X-ray, which showed free air, was used
in the diagnosis of PUP in the hospital setting during the study
period. A previous study used fast ultrasound or computerized
tomography scan to confirm diagnosis and early treatment of
PUP as plain abdominal X-ray does not always prove perforation,
particularly in the early stages.14,15 Several case series
have shown that in 30%–50% of patients, the X-ray may be
negative for free air, particularly in the elderly.15 Unfortunately,
ultrasound and computed tomography scans are limited in a
developing country such as Thailand. Therefore, most cases in
this study could not be confirmed by using this equipment.