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Perforated peptic ulcer — MCCQE Part 1 MCQ

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HardAbdominal PainPerforated peptic ulcerMCCQE Part 1

A 66-year-old man with sudden severe epigastric pain appears pale and rigid. He takes naproxen for osteoarthritis. BP is 92/60 mmHg, pulse 122/min, and upright chest radiograph shows free air under the diaphragm. What is the most appropriate next step in management?

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Correct answer: E — Resuscitate and arrange urgent surgical intervention

Free intraperitoneal air with peritonitis and shock indicates perforated viscus, likely perforated peptic ulcer in this NSAID user; resuscitation and urgent surgery are required. Outpatient acid suppression or delayed gastroscopy would be dangerous. Barium contrast can worsen peritonitis and is not needed when free air is already demonstrated. Immediate source control matters.

Reference: Canadian Association of General Surgeons emergency surgery resources