A Perforated Duodenal Ulcer after Using of Methamphetamin and Methadone

Acute poisonings with corrosive substances lead to serious peptic ulcer disease despite of the major improvements in both diagnostic and therapeutic strategies; perforated peptic ulcer is still the most common cause of gastrointestinal perforation and the second most common complication of the peptic ulcer. Duodenal ulcers tend to be the posterior penetrating and in pancreas can cause pancreatitis whereas gastric ulcers are penetrating to left liver’s lobe.Case Report: We report the case of a 23-year-old man with a history of chronic consumption of methamphetamin and methadone referred to emergency state with epigastric pain. He consumed methamphetamin following about 10cc methadone, then amount of methadone syrup yesterday. When he was admitted, he was awake, alert, agitated and restless; also he was feeling abdominal pain. In examination, we found out generalized abdominal pain with garding and rebound tenderness. Pain is continuously and referred to back and the testis. The pupils had mild mydriasis and reactive to light. Free subdiphragmatic air was seen in the right subphrenic area in upright chest x-Ray. It didn’t administrate to activated charcoal due to perforation detection and immediately he was transferred to the operating room for diagnosis an acute abdomen. Purulent discharge was seen between the left lobe of liver and gastric as well as adhesion of omentum. Then, post pyloric perforation was seen after release of adhesion that bile discharge excreted. We treated him with essential treatment. Here, we report a patient with a history of addiction to methamphetamin and methadone and perforated duodenal ulcer after took acute overdose of these substances. As a result of that perforation opened and postulated to the left lobe of liver, thus he was taken to the operating room. This patient had perforated duodenal ulcer after acute overdose of methamphetamin and also this ulcer opened atypically to the left lobe of liver. Furthermore, investigation on the effects of amphetamine and methamphetamine on peptic ulcer and its effect on the perforation is recommended.