Differential Diagnosis :

Only after ruling out perforated peptic ulcer under the circumstances look for possible acute pancreatitis (serum amylase +++) or other causes of acute abdomen.

Management as a Family Practitioner:
• Must be able to diagnose this by clinical exam
• N.G. suction
• Correct dehydration and electrolyte balance in preparation for surgery (closure of perforation with or without surgery for Acid Peptic disease).