An acute free perforation of a duodenal ulcer presents a picture that should seldom confuse it with the more common of the abdominal lesions. The sudden and usually terrific onslaught of pain which drops the patient as though shot, the bilateral boardlike rigidity, and the complete physical collapse that accompany the accident, usually serve clearly to define its nature.
Obviously, the chief concern of the surgeon in the case of the acute abdomen is to decide the necessity for surgical intervention. This done, a differential diagnosis should, if possible, be made. In the case I wish to report, the interest centers about two interesting conditions: First, there were two coincidental acute lesions, both in the upper abdomen; second, the clinical picture suggested neither of the two lesions.
REPORT OF CASE
—Mrs. P., aged 29, who entered Wesley Memorial Hospital, September 21, 1918, referred by Dr. J. G. Campbell, began