A case report of duodenal and enteric perforation in a single patient

Background: The presence of two hollow viscus perforations in a single patient is a rare entity and no case report is available in the literature which shows the finding of duodenal ulcer perforation and enteric perforation in the same patient. Case presentation: A 55-year-old male presented in the emergency department of East Surgical Ward of Mayo Hospital, Lahore, Pakistan, in January 2020 with complaint of abdominal pain and vomiting for the past 3 days and fever for the past 5 days. He was a chronic smoker with a history of 10 pack-years. On examination, he had tachycardia with a pulse rate of 114 beats/minutes and respiratory rate was 30/minutes and his whole abdomen was guarding with absent bowel sounds. X-ray of the chest showed free gas under the right hemidiaphragm. The patient was resuscitated and plan of exploration was made with diagnosis of perforated duodenal ulcer. We found a 0.5 x 0.5 cm perforation on the anterior surface of the first part of the duodenum along with a 1 x 1 cm perforation on antimesenteric surface of ileum that is 1 feet proximal to ileocolic junction. Graham's patch repair was carried out for duodenal perforation, while loop ileostomy was made for ileal perforation. The patient was discharged on the 5th postoperative day. The reversal of loop ileostomy was carried out after 2 months. Conclusion: In cases of peritonitis, general inspection of the whole gastrointestinal tract plays a very important role as more than one hollow viscus perforation can be found in a single patient which can be missed and can lead to peritonitis again.