Appendix E

 Algorithm of diagnosis and treatment

of perforated ulcer

(obligatory)

 

Acute abdominal pain “due to stabbing with a dagger”

 

 

Abdominal X-ray

 

 

Pneumoperitoneum

 

   

Yes                                                                No

 

 

                     Gastroduodenoscopy   Ultrasonic   Laparoscopy

+

                                X-ray

 

 

                                                                  Free liquid

 

 

                                                               Laparocentesis

 

 

 

Perforated ulcer

 

 

                                  Open                    Laparoscopic

 procedure                      repair