Question

A patient presents with acute–onset, severe abdominal pain. He is hemodynamically stable. A chest X-ray is shown below. What is the next step in management?

• A. Gastric lavage
• B. Chest tube insertion
• C. Tracheostomy
• D. Resuscitation and laparotomy

Answer 1

The Correct Option is D

In cases where a patient presents with acute-onset, severe abdominal pain but remains hemodynamically stable, a serious intra-abdominal condition such as perforation should be suspected. The question provides a chest X-ray, which often reveals indications such as free air under the diaphragm, suggesting perforation of a hollow viscus, typically due to conditions like a perforated peptic ulcer.

Given the clinical signs and imaging findings, the next step in management is crucial. The primary objective is to prevent further deterioration. The options provided are:

Option	Description
Gastric lavage	Used to clear stomach contents, not relevant for perforation management.
Chest tube insertion	Indicated for thoracic issues like pneumothorax, not abdominal emergencies.
Tracheostomy	A procedure to secure the airway, unnecessary here as the patient is stable.
Resuscitation and laparotomy	Immediate surgical intervention for abdominal emergencies, such as perforations.

The correct approach involves resuscitation to stabilize the patient, followed by laparotomy, which allows direct surgical correction of the presumed perforation. Among the options, "Resuscitation and laparotomy" is the appropriate choice given the clinical scenario of acute abdominal pain with supporting X-ray findings.