Matters of the Heart: Simultaneous Pneumoperitoneum and Acute Inferior Wall Myocardial Infarction

A 70-year-old man with a history of peptic ulcer disease presented with a 1-day history of epigastric pain. Abdominal examination revealed mild epigastric tenderness. A pneumoperitoneum was discovered on a chest film (A), and a left decubitus chest film (B) confirmed this diagnosis. An ECG demonstrated signs of acute inferior wall myocardial infarction (MI). In addition to the standard management of acute MI, this patient underwent emergency surgical repair of the perforated duodenal ulcer, from which he recovered fully. Epigastric pain could be the presenting symptom of inferior wall MI. However, a coexisting pneumoperitoneum should be suspected in a patient with a peptic ulcer.