Matters of the Heart: Simultaneous Pneumoperitoneum and Acute Inferior Wall Myocardial Infarction

May 2, 2004
Samer Alkhuja, MD
Samer Alkhuja, MD

A 70-year-old man with a history of peptic ulcer disease presented with a 1-dayhistory of epigastric pain. Abdominal examination revealed mild epigastrictenderness. A pneumoperitoneum was discovered on a chest film (A), and aleft decubitus chest film (B) confirmed this diagnosis.

A 70-year-old man with a history of peptic ulcer disease presented with a 1-dayhistory of epigastric pain. Abdominal examination revealed mild epigastrictenderness. A pneumoperitoneum was discovered on a chest film (A), and aleft decubitus chest film (B) confirmed this diagnosis.An ECG demonstrated signs of acute inferior wall myocardial infarction(MI). In addition to the standard management of acute MI, this patient underwentemergency surgical repair of the perforated duodenal ulcer, from whichhe recovered fully.Epigastric pain could be the presenting symptom of inferior wall MI. However,a coexisting pneumoperitoneum should be suspected in a patient with apeptic ulcer.