Abstract
We report a case of giant duodenal ulcer perforation with septic shock and hyperkalemia in which intensive treatment saved the subject. A 68–year–old man treated regularly elsewhere for lumbar spinal canal stenosis was seen in an emergency for lumbar backache lasting 10 days. Abdominal computed tomography (CT) showed free air and ascites. Decreasing blood pressure immediately after CT prompted dopamine administration. Following abdominal swelling and peritoneal irritation over the entire abdomen, a blood test confirming hyperkalemia necessitated calcium gluconate injection and immediate surgery. Laparotomy showed a giant two–thirds circumferential 5×3.5 cm duodenal ulcer perforation in the anterior duodenal bulb wall, containing 2,300 ml of purulent ascites. Simple duodenal closure, omentopexy, jejunostomy, and abdominal cavity drainage were done because blood pressure could be maintained during surgery with 0.3 μg/kg/min of norepinephrine. Continuous postoperative hemodiafiltration was done under mechanical ventilation in the ICU, gradually improving the man's general condition.
