Clinical Challenges in Managing a Dengue Positive Patient Presenting as Perforated Duodenal Ulcer

Introduction: Acute abdomen in Dengue Fever patient poses a distinct and formidable challenge in diagnosis and management. Perforated duodenal ulcer is a rare presentation of Dengue Fever. Surgeons face formidable challenges in diagnosing, resuscitating and delivering optimum post-operative care for such patients.

Case Presentation: A 26 years old gentleman presented with acute abdominal pain for 3 days and peritonism over the right side of abdomen. His serology investigation and NS1 antigen was positive. Perforated duodenal ulcer was confirmed by a CECT abdomen.

He was taken for a laparotomy and the ulcer was repaired with the Heineke-Mikulicz pyloroplasty technique. Post-operative care was meticulous regarding the fluid status with account of the capillary leakage which occurs during defervescence phase of dengue fever. An oral contrast study was done on day 5 to confirm the integrity of the repair prior to commencement of oral feeds.

Conclusion: Managing this patient successfully highlights the importance of active participation from both physician and surgeon. An increased clinical vigilance to possible post-operative complications and close monitoring as the patient progresses to the defervescence phase of dengue fever are important to minimising the adverse physiological stress to this patient.