Concurrent Gastric Outlet Obstruction and Perforation Complicating Chronic Peptic Ulcer Disease 1 2 Saliu Adetunji OGUNTOLA (FWACS) , Olateju Olushola AKANBI (FWACS) , 1 1* Tayewo AKINLOYE (MWACS) , Najeem Adedamola IDOWU (MWACS) 1 Department of Surgery, Ladoke Akintola University of Technology Teaching Hospital, Ogbomoso, Oyo State, Nigeria 2 Federal Medical Centre, Keffi, Nasarawa State, Nigeria Abstract Common complications of peptic ulcer disease that require the attention of general surgeons are upper gastrointestinal tract haemorrhage, gastric outlet obstruction, and perforation. There have been reports of haemorrhage and perforation occurring together in some patients. We herein report a case, possibly the first in English literature, of concurrent gastric outlet obstruction and perforation complicating chronic peptic ulcer disease. Our objective is to draw readers' attention to the possibility of this combination of complications and its likely pathogenesis. The medical specialist should always consider the likelihood of synchronous existence of multiple complications in patients with long history of peptic ulcer disease. This will allow planned holistic care of patients. Introduction The common complications of peptic ulcer disease are hemorrhage, perforation, and [1] obstruction. The most common complication is hemorrhage, followed by perforation, and [2] then obstruction. Some other rare complications that have been reported in the [3] literature are intramural duodenal hematoma [4] and choledochoduodenal fistula. There are also reports of combined complications of upper gastrointestinal hemorrhage and [5] perforation. Generally patients with peptic ulcer disease present with epigastric pain, bloating, nausea, and vomiting in the [6] uncomplicated state; however in the event of complications, they present with haematemesis, abdominal distention, and generalized, worsening abdominal pain, [7] depending on the type of complications. We herein present an interesting case of concurrent gastric outlet obstruction and duodenal perforation in a patient with chronic peptic ulcer disease. Case A 58-year-old male farmer presented with a week history of sudden onset of abdominal pain, abdominal distention, and 6-day history of vomiting. He couldn't characterize the pain, but the vomitus was bilious and vomiting occurred not more than twice a day. He had an antecedent 4-year history of dyspepsia for which he had been taking antacid. He denied history of haematemesis, melaena or weight loss. He had been in a private hospital in a nearby town, from where he was referred to our hospital. He was acutely ill-looking, in moderate painful distress, dehydrated, anicteric, acyanosed, afebrile, and had no pedal oedema. The vital signs were only remarkable for tachycardia of 110 beats/min and tachypnoea PAGE 44 Corresponding email address: idowunajeem0@gmail.com