ABSTRACT
Peptic ulcer is relatively common and in 2% of patients may present with sudden perforation without previous history of peptic ulcer disease. Early diagnosis and management can save the patient. A 79-year-old man was presented to emergency room with gross hematuria and clot uninary retention. A 3-4 cm vegetative mass was in left lateral wall of bladder in cystoscopy. Under spinal anesthesia, transurethral resection was performed without any complication. The day after surgery, patient had developed generalized abdominal pain and guarding and hematuria with urinary retention. Emergency abdominal sonography revealed free fluid in pelvis with possible bladder perforation. Laparotomy was performed and there was no bladder perforation except a little extra and intra peritoneal clear fluid. With a cystectomy tube and two intra and extra peritoneal drains laparotomy was closed. Two days after the second surgery, liquid diet was started for patient, but it was associated with fecal oderous leakage from the drains. After consultation with general surgeons with diagnosis of trauma to rectum or lieum again laparotomy was performed. In re-exploration there was a perforation in stomach [anterior aspect of pylores], so it was repaired and a few days later with normal general condition patient was discharged. Although peptic ulcer disease is relatively common. Its perforation with association of other surgeries in these patients is very rare and can mimic the complication of T.U.R.B.T. So close observation of patients and proper management can save the patients