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Perforated viscus — MCCQE Part 1 MCQ

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HardAbdominal PainPerforated viscusMCCQE Part 1

68-year-old man using nsaids presents with sudden severe epigastric pain. He is rigid with free air under the diaphragm on CXR. Which of the following is the most appropriate next step?

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Correct answer: B — Give IV fluids, broad-spectrum antibiotics and urgent surgical consultation

Give IV fluids, broad-spectrum antibiotics and urgent surgical consultation is best because peritonitis with free air indicates perforated viscus. Discharge with oral analgesia only is suboptimal because analgesia alone may mask a surgical emergency; Delay surgical assessment until routine clinic is suboptimal because time-sensitive surgical presentations require urgent assessment; Treat with laxatives or antacids as sole therapy is suboptimal because a benign gastrointestinal explanation does not account for the red flags; Perform an invasive bedside procedure without imaging or senior input is suboptimal because invasive treatment can worsen outcomes when anatomy or diagnosis is uncertain. This is a surgical emergency even if the pain temporarily improves.

Reference: Canadian Association of General Surgeons guidance