Patient is on autocoids for 1 year complains of severe pain epigasrium relieved iv antacids now complains of pain in right iliac fossa and epigastrium with fever and loss of liver dullness diagnosis

Answer- A. Duodenal perforationLong term therapy with autocoids led to an ulcer that eventually perforated and now the patient has presented early signs of peritonitis.Clinical features of perfontion of duodenal ulcerPerforated duodenal ulcer is characterized by sever constant onset epogastric painPatient looks ill and lies unusually stillTachycardiaShallow respirationTender with intense guarding and rigidityIf the air has escaped into peritoneal cavity then liver dullness may be absentPeptic ulcer perforation leads to chemical peritonitis initially.