Case: 24 year old male with no significant history presented with acute epigastric pain radiating to shoulders?
Answer: Free air under the diaphragm (both sides) secondary to perforated duodenal ulcer.
In patients presenting with complicated peptic ulcer disease, nearly half have no history of the disease! In younger patients, severe abdominal pain, which may radiate to the shoulder, may be the initial presentation.
Reference: click to get article
Perforated Peptic Ulcer - emadmag.com
