Case Presentation:
The patient was a 71-year-old man who presented to an educational
hospital, Poursina Medical Center, in Rasht, Guilan, Iran, in February
2022, with the chief complaint of abdominal pain. The pain started the
day before. It was periumbilical, was not positional, and was not
contributed to the feeding or defecation. In the beginning, it was
intermittent, and then it developed to be persistent. He did not give a
history of nausea and vomiting. The patient had a past medical history
of hypertension (HTN) and an old cerebrovascular accident (CVA). His
past drug history was unrevealing. On arrival, he had normal vital
signs: a pulse rate (PR) of 78, respiratory rate (RR) of 13, blood
pressure (BP) of 100/40, and he was not febrile (Temperature (T)= 37.2).
On physical examination, the inspection was normal, the bowel sounds
were decreased on auscultation, and there was a generalized tenderness
in palpitation, with the dominance of the epigastric area. A positive
rebound test was also detected on the epigastric area, which favored the
acute abdomen. The patient was asked to do an up-right chest and supine
abdominal X-ray, which didn’t show any specific changes, as can be seen
in figures 1and 2. The abdominal ultrasonography was also done. It
revealed free fluid in the pre-splenic and sub hepatic spaces and
Morrison’s pouch. A thorough blood exam was done on the arrival date
(Table 1). The rise in the level of pancreatic enzymes (amylase=2320 and
lipase=1854), c-reactive protein (CRP=72), and creatine phosphokinase
(CPK=631) all were in favor of the incidence of acute pancreatitis. Due
to the positive acute abdomen, generalized tenderness in physical
examination, the patient underwent laparotomy. A sealed-off, 1cm*1cm pre
pyloric perforated peptic ulcer was seen with localized debris and free
fluid in the epigastric area. Debris was cleaned out, gastrorrahphy and
omental patch were done, and the abdominal incision was closed. The
patient was hospitalized for ten days. 4 days after the surgery, he was
NPO and treated with intravenous liquids. After that, he started to eat
food and got PO, and was under control. After five days, due to the
decreasing pattern of pancreatic enzymes, as can be seen in table 2, and
the stable clinical condition of the patient, he got discharged.