A stitch in time saves nine! A case report of spontaneous duodenal perforation in advanced pancreatic cancer

A stitch in time saves nine! A case report of spontaneous duodenal perforation in advanced pancreatic cancer

Acute abdomen, Emergency department, Palliative care, Point of care ultrasound (POCUS)

Acute abdomen is a common presentation in the emergency department, requiring prompt evaluation, diagnosis,
and treatment. This case report highlights how simple diagnostic tools can facilitate early detection of abdominal
pain caused by duodenal perforation—a rare complication in patients with locally advanced pancreatic cancer.
We present a novel case of a 62-year-old male with locally advanced pancreatic cancer who developed acute
abdominal pain. The diagnosis of intestinal perforation was made at a Specialist Palliative Care clinic within
a tertiary cancer centre. An erect abdominal X-ray revealed free air under the diaphragm, pointing to bowel
perforation. The patient underwent emergency surgical exploration, which confirmed a duodenal perforation and
was managed with a palliative gastrojejunostomy. While point-of-care ultrasound (POCUS) was not used in this
case, we emphasize its potential utility as a bedside tool in the emergency setting for early evaluation of acute
abdomen. It can aid in differentiating between conditions such as bowel obstruction, perforation, intussusception,
abscesses, or large masses compressing vital structures—many of which may not be visible on a plain abdominal
X-ray. This case underscores the importance of early clinical evaluation and the use of accessible diagnostic tools
(POCUS) in the timely management of acute abdomen, particularly in complex cancer cases.
Keywords Acute abdomen, Emergency department, Palliative care, Point of care ultrasound (POCUS)

Isha Jatin Shah1

, Raghu Sudarshan Thota1* , Jayita Deodhar1

and Shamali Poojary1

2025

Peri Irawan

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