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.