Giant Perforated Duodenal Ulcer with Complete Common Bile Duct Erosion in an Elderly Patient: A Rare, Fatal Complication of NSAID Use – First Reported Case Worldwide

Background:The liberal use of non-steroidal anti-inflammatory drugs (NSAIDs) can be potentially fatal, especially in the elderly.NSAIDs are commonly associated with peptic ulcer diseases (PUD), may lead to bleeding and perforations.However, PUD perforation associated with complete erosion of common bile duct (CBD) has not been reported in the English literature before.We present the world's first documented case of complete erosion of CBD with duodenal ulcer (DU) perforation secondary to the use of NSAIDs in an elderly patient.Case Report: An 87-year-old female with one month history of right hip replacement presented to the emergency department with two-day history of epigastric pain.She had been using NSAIDS (diclofenac) for her hip pain.On examination she was found to be in septic shock with a peritonitis abdomen, and erect chest X-ray revealed a large pneumo-peritoneum.After resuscitation, patient consented for an emergency exploratory laparotomy.Intra-operatively, a giant ulcer involving 70-80% the circumferences of the first part of the duodenum with complete erosion of the common bile duct were discovered.Damage control surgery was done, but the patient became hemodynamically unstable post-operatively and passed away on day two of the surgery.Conclusion: While NSAIDs are widely used for pain management, careful consideration is necessary when prescribing them to elderly patients.This case highlights the potentially catastrophic complications of NSAID use in older adults.