A 34-year-old man suddenly develops severe epigastric pain radiating to the back, becomes still and tachycardic, and has board-like rigidity of the abdomen. Erect chest radiograph shows free air under both hemidiaphragms. At laparotomy, a perforated peptic ulcer is found. Where is such perforation characteristically located?
- A Anterior wall of the first part of the duodenum ✓
- B Posterior wall of the first part of the duodenum
- C Greater curvature of the gastric body
- D Posterior wall of the gastric fundus
Correct answer: A. Anterior wall of the first part of the duodenum
Explanation
Anterior duodenal ulcers are thin-walled and lack the protective covering of adjacent organs, so they perforate freely into the peritoneal cavity causing pneumoperitoneum. Posterior duodenal ulcers sit against the gastroduodenal artery and typically erode it, presenting with massive hemorrhage rather than perforation. Gastric ulcers occur on the lesser curvature most commonly, and perforations of gastric ulcers are far less frequent than duodenal ones. This anterior versus posterior distinction is a classic examination discriminator between perforation and bleeding.
Reference: Bailey and Love's Short Practice of Surgery, 27th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.