Silent Abdomen, Loud Emergency: A Case Report of Gastric Perforation in Low-Resource Area

Abstract

Background: Gastric perforation is a serious condition that requires quick diagnosis and treatment. Delays can lead to high death rates. In remote areas with limited resources, managing this condition is especially difficult due  to the lack of nearby healthcare, imaging tools, surgery facilities, and patient transport. This case report highlights how gastric perforation can present in such settings and the challenges faced in managing it.

Case Presentation: An 80-year-old man came with severe abdominal pain, shortness of breath, and fever for over four days. He appeared pale, hypotensive, and tachycardic signs of shock. The ABCDE approach showed shallow breathing, weak pulses, and abdominal tenderness. He had a history of epigastric pain, alcohol use, smoking, and frequent PPI use. A chest X-ray showed signs of pneumonia. Lab tests revealed severe anemia, slightly slightly elevated leukocyte count, and elevated kidney markers. He was treated for sepsis (qSOFA 2, CURB-65 score 3) and responded with temporary stability. However, his abdominal pain worsened. An abdominal X-ray showed free air, and emergency surgery confirmed a gastric perforation, which was repaired. By day 11, he improved and was discharged. On follow-up at Karitas Weetabula hospital, he remained clinical recovery.

Conclusion: his case shows how hard it can be to treat serious conditions like gastric perforation in remote areas with limited resources. Without advanced tools, doctors often rely on clinical judgment and experience. Good teamwork, even with few resources, is crucial for quick treatment and better patient outcomes