GI Perforation: 

• Can be complication of PUD 
• Abrupt severe, generalized abdominal pain 
• GI content spills into peritoneum > chemical then bacterial peritonitis
• Rigid abdomen, peritonitis (not always seen in older patients) 

ABC, 2 large-bore IVs, O2, Monitor,

Basic labs + type and screen

NG tube with suction

Abdominal series Xray to assess for free air (not always visible)

Broad spectrum Abx (including anaerobic coverage)

Surgery consult

Sometimes patients are stable enough to CT which often reveals dx 

Operative intervention is standard of care. 

References

1. Angela M. Bogle and Matthew C. Gratton. “Chapter 78: Peptic Ulcer Disease and Gastritis.” In Tintinalli, Judith E., et al. Tintinalli's Emergency Medicine: a Comprehensive Study Guide. McGraw-Hill, 2016.