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Perforated peptic ulcer — RCPSC EM MCQ

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ModerateGI/Abdominal emergenciesPerforated peptic ulcerRCPSC EM

CTAS 2. A 58-year-old has sudden epigastric pain and shoulder-tip pain. BP is 102/64 mmHg, HR 112, abdomen is rigid, and lactate is 2.9 mmol/L. Upright chest x-ray shows possible free air. What is the most appropriate investigation?

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Correct answer: A — CT abdomen and pelvis with IV contrast

In a stable patient with peritonitis and suspected perforation, CT helps confirm free air, define source, and guide operative planning.

Reference: Canadian Association of General Surgeons acute abdomen resources