This case is of unusual interest (1) because of the diagnostic problem that presented itself and (2) because of the direction in which the gastroduodenal fluid drained. In a review of the literature no reference to a spontaneous rupture of a duodenal ulcer draining retroperitoneally could be found.
A white man aged 39 of average height and rather thin, a clothing salesman, returned home one evening complaining of severe headache, pains radiating through the trapezius area and generalized aching with particular reference to the back. Thinking that he was suffering from influenza, he took a dose of castor oil about 10 p. m. Sleep overtook him until 5 a. m., at which time the bowels became obstreperous, watery elimination requiring attention on four occasions until 11 a. m. The last of these movements was dark but not black, according to the patient. He also stated that the entire
LeBauer SF, Patman WL. RETROPERITONEAL RUPTURE OF A DUODENAL ULCER. JAMA. 1939;113(1):36–38. doi:10.1001/jama.1939.72800260002011a
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