Arab Board Surgery Clinical Practice Questions - Arab Board General Surgery Final Clinical And Oral Exam

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A 46-year-old male with a history of heavy NSAID use presents with sudden, agonizing, catastrophic epigastric pain that began 4 hours ago. On examination, he is diaphoretic with shallow respirations, pulse 118 bpm, and diffuse abdominal board-like rigidity with involuntary guarding and absent bowel sounds. An erect chest radiograph demonstrates crescentic free air under both diaphragmatic copulae. At emergency exploratory laparotomy, a 0.7 cm clean-edged perforation is identified on the anterior prepyloric gastric antrum with moderate peritoneal contamination. What is the most appropriate surgical procedure?

Distal subtotal gastrectomy with Roux-en-Y gastrojejunostomy Thorough peritoneal lavage and Graham patch omentopexy closure of the perforation Simple primary two-layer suture closure without omental reinforcement Truncal vagotomy, antrectomy, and Billroth I gastroduodenostomy

Correct Answer:

Thorough peritoneal lavage and Graham patch omentopexy closure of the perforation

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