Rare case of perforated giant gastric ulcer with concurrent thyroid storm:A case report

作     者：Jasper Xiangwei Wang Lin Seong Soh Dinesh Carl Junis Mahendran Chang Yi Woon Clement Luck Khng Chia 

作者机构：Department of General SurgeryKhoo Teck Puat HospitalSingapore 768828Singapore Department of EndocrinologyKhoo Teck Puat HospitalSingapore 768828Singapore Yong Loo Lin School of MedicineNational University of SingaporeSingapore 117597Singapore 

出 版 物：《World Journal of Surgical Procedures》 (世界外科手术杂志)

年 卷 期：2022年第12卷第1期

页      面：8-12页

学科分类：1002[医学-临床医学] 100201[医学-内科学(含：心血管病、血液病、呼吸系病、消化系病、内分泌与代谢病、肾病、风湿病、传染病)] 10[医学] 

主　　题：Peptic ulcer Perforated viscus Thyroid storm Multidisciplinary Grave’s disease Case report 

摘      要：BACKGROUND Thyroid storm is an uncommon condition manifesting in severe thyrotoxicosis with a high mortality *** concurrence of peptic ulcer disease and hyperthyroidism is rare due to concurrent activation of both the sympathetic and parasympathetic *** present a case of perforated giant gastric ulcer with concurrent thyroid storm who underwent damage control surgery with emergency patch repair with falciform ligament and recovered *** SUMMARY A 53-year-old male chronic smoker,with no previous medical history,presented with severe generalized abdominal pain and vomiting for one day *** history revealed weight loss,diarrhea,and anxiety over the past three *** clinical examination,patient was febrile with temperature of 38.6 Degrees Celsius and tachycardic at 130-140 beats per minute,his blood pressure was low at 90/*** abdomen was tender with generalized *** view of his clinical history,a thyroid screen was ordered which showed raised thyroxine(T4)levels of 90.3 pmol/L and low thyroxine stimulating hormone(TSH)levels of 0.005μU/*** X-ray showed no sub-diaphragmatic free air,but contrasted CT scan revealed pneumoperitoneum with large amount of intraabdominal free *** working diagnosis was perforated peptic ulcer complicated by thyroid *** urgent endocrinologist consult was made,and patient was started on beta blocker and intravenous steroids *** patient underwent emergency laparotomy with washout and patch repair of the perforated gastric *** was monitored post-operatively in intensive care unit and required IV hydrocortisone and Lugol’s *** of the ulcer edges showed no *** post-operative day seven,T4 decreased to 20.4 pmol/L,TSH was 0.005 mLU/*** thyroid function test subsequently normalized 3 mo post-operatively with T418.1 pmol/L,TSH 1.91 mLU/***’s recovery was otherwise *** receptor antibody subsequently was positive,and pa