Clinical Practice and Cases in Emergency Medicine

Acute myocardial infarction and perforated peptic ulcer disease with associated peritonitis are bothmedical emergencies requiring urgent intervention. This patient presented with both emergenciessimultaneously. Current literature is devoid of guidance as to which should be addressed initially. Amultidisciplinary discussion was conducted leading to a unanimous decision for initiating percutaneouscoronary intervention (PCI). After successful PCI, the patient was immediately taken to the operatingroom for laparoscopic repair of the perforated viscous. Subsequent to the operative repair, the patientbecame hemodynamically unstable and a repeat electrocardiogram demonstrated complete rightcoronary occlusion. Shock ensued and the patient died in the intensive care unit despite this plan ofcare. It is our opinion that this case reveals the need for expert panels to devise decision algorithms forconcomitant presentations of life-threatening diseases.