Patient is on Autocoids for 1 year now complains of severe pain Epigastrium relieved by antacid drugs. He complaints of Right Iliac fossa pain and loss of liver dullness. Diagnosis is:

Ans. (a) Perforation of duodenum* This is a clear-cut case of drug induced ulcer and perforation - Duodenal ulcer perforation* Features are diffuse abdominal pain with right iliac fossa pain due to tracking of pus in right colic gutter - Valentino Syndrome* Obliteration of liver dullness* Board like rigidity