Perforated peritonitis in a super-old patient successfully managed with nonoperative intensive treatments: A case report

Abstract

A 96-year-old woman was transferred to our department owing to complaints of abdominal pain. On admission, she appeared drowsy and was tachypneic. Plain abdominal computed tomography showed presence of intraperitoneal free air and ascetic fluid. Her condition was then diagnosed as acute cardiorespiratory failure due to perforated localized peritonitis, and the stomach was suggested to be the perforation site. Thus, conservative treatment was initiated after obtaining informed consent from the patient’s family. Percutaneous peritoneal drainage was initially conducted, and 2,000 mL of muddy yellow fluid was aspirated. Thereafter, intensive treatments including mechanical ventilation; administration of catecholamines, antibiotics, and proton pump inhibitors; gastric decompression using a nasogastric tube; and total parenteral nutrition were initiated. Although the patient’s condition was complicated with acute kidney injury, congestive heart failure, and disseminated intravascular coagulation, she eventually recovered and was transferred from the intensive care unit to a medical ward on hospital day 13. After undergoing rehabilitation for muscular atrophy of the lower extremities, she was finally discharged on hospital day 58. Nonoperative intensive treatments may be useful for perforated peptic ulcer in super-old patients.