Int J Intern Emerg Med | Volume 1, Issue 1 | Case Report | Open Access

A Balloon-Like Epigastric Hernia and Bilateral Shoulder Pain

Stamatis Karakonstantis*, Ifigeneia Kassotaki, Despoina Arna and Dafni Korela

2ndDepartment of Internal Medicine, General Hospital of Heraklion Venizeleio-Pananeio, Greece

*Correspondance to: Stamatis Karakonstantis 

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Abstract

Background: Any abdominal pathology associated with diaphragmatic irritation may result in pain referred to the shoulders. Here we present an unusual case presenting with bilateral shoulder pain and an air-filled epigastric hernia as a result of a ruptured gastric ulcer.
Case Report: An 84-year-old male presented to the emergency department due to upper abdominal pain. He reported acute left shoulder pain starting the night before. Within several hours the pain had moved to the upper abdomen and then to the right shoulder. An air-filled epigastric hernia noted on physical examination raised the suspicion for pneumoperitoneum. This was confirmed by an erect chest x-ray (demonstrating sub diaphragmatic air) followed by an abdominal computed tomography. Emergency laparotomy revealed a perforated gastric ulcer.
Discussion: Gastric ulcer perforation should be considered in the differential diagnosis of shoulder pain, along with the many other causes of referred shoulder pain. Of note is that shoulder pain as a result of gastric perforation may precede the abdominal pain by many hours.

Citation:

Karakonstantis S, Kassotaki I, Arna D, Korela D. A Balloon-Like Epigastric Hernia and Bilateral Shoulder Pain. Int J Intern Emerg Med. 2018;1(1):1001.

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