ULTRASOUND DIAGNOSIS OF PEPTIC ULCER PERFORATION - A CASE REPORT/ULTRAZVUCNA DIJAGNOSTIKA PERFORIRANOG PEPTICKOG ULKUSA PRIKAZ SLUCAJA

Introduction. Peptic ulcer perforation is an urgent, life-threatening condition that requires prompt diagnosis and emergency surgical treatment. It is a focal defect of the pylorobulbar zone that affects all the layers and allows intraluminal content to leak into the peritoneal/retroperitoneal cavity. The aim of this study is point to ultrasonography as a good diagnostic modality in identifying peptic ulcer perforation when it is clinically unrecognized. Case Report. We report a case of a 36-year-old man who came to the Emergency Center of the Clinical Center of Vojvodina complaining of a sudden severe pain in the entire abdomen. The patient reported previous dyspeptic symptoms. Emergency transabdominal ultrasonography was perfomed, and a peptic ulcer perforation was suspected. It significantly shortened the time to urgent surgical treatment and the diagnosis was confirmed. Conclusion. Pneumoperitoneum, collection of extraluminal free fluid with gas bubbles around the lesion, inflammatory thickening and discontinuity of the pylorobulbar wall, with or without focal hyperechogenic line (perforation zone) are ultrasound findings suggestive of peptic ulcer perforation. Key words: Peptic Ulcer Perforation; Ultrasonography; Diagnosis; Stomach Ulcer; Duodenal Ulcer; Signs and Symptoms Uvod. Perforacija peptickog ulkusa je urgentno, zivotno ugrozavajuce stanje koje zahteva brzu dijagnostiku i sto raniji hirurski tretman. Predstavlja fokalni defekt koji zahvata sve slojeve zida pilorobulbarne regije i omogucava isticanje intraluminalnog sadrzaja u peritonealnu/retroperitonalnu duplju. Cilj ovog clanka je da podseti citaoca da ultrasonografija moze biti ponekad dobar dijagnosticki modalitet u postavljanju sumnje na klinicki neprepoznate perforacije peptickog ulkusa. Prikaz slucaja. Predstavljamo 36-godisnjeg muskaraca koji dolazi u Urgentni centar Klinickog centra Vojvodine zbog naglo nastalih jakih bolova u celom trbuhu. Od ranijih tegoba navodi dispepticke tegobe. U sklopu urgentnog protokola nacinjena je ultrasonografija abdomena zbog sumnje na perforaciju peptickog ulkusa, sto je znacajno skratilo vreme do urgentnog hirurskog tretmana koji je potvrdio postavljenu dijagnozu. Zakljucak. Pneumoperitoneum, perileziona ekstraluminalna slobodna tecna kolekcija sa mehuricima gasa i inflamatorna zadebljanja i prekid kontinuiteta zida pilorobulbarne regije sa/bez fokalne hiperehogene linije zone perforacije su ultrazvucni kriterijumi za postavljanje sumnje na perforaciju