A 45 years old male with history of chronic duodenal ulcer was brought to the emergency in the state of shock. After resuscitation, patient was sent for investigations. Chest X-ray is given below. What is the preferred treatment option?
X-ray: * Gas under Right dome of diaphragm -Pneumoperitoneum Perforation peritonitis * Pneumoperitoneum Anteriorly located ulcers- PerforatePosteriorly located ulcers- Bleed - Due to GDA - Massive bleeding SxOC- Omental patch repair / modified graham's repair Asymptomatic causes of gas under the diaphragm: Thoracic Abdominal Gynecological PEEP ventilation Pneumothorax/ pneumomediastinum CPR with mouth to mouth ventilation Pulmonary TB Postop- after laparoscopy Endoscopic procedures Pneumatosis cystoides intestinalis Pelvic insufflation PID Pneumatosis cystoides intestinalis- transient, thin cysts containing nitrogen in submucosa & subserosa of small bowel due to | intraluminal pressure These gas filled cysts may rupture into peritoneal cavity to cause sterile pneumoperitoneum C/F- abdominal distension, pain, vomiting, bowel disturbances Complications- intestinal obstruction, hemorrhage, perforation Rx- Oxygen therapy, metronidazole
Modified Graham's repair
Truncal vagotomy with antrectomy
Truncal vagotomy with gastrojejunostomy
Billroth I gastrectomy
GIT