Abstract
INTRODUCTION: Laparoscopic surgery is increasingly performed for peptic ulcer perforation, but its application in patients with severe scoliosis remains controversial due to anatomical challenges and respiratory dysfunction. We report a case of a patient with severe scoliosis who developed respiratory failure from a perforated peptic ulcer and underwent emergency laparoscopic surgery. PRESENTATION OF CASE: A 51-year-old man was transferred to the hospital by ambulance for sudden abdominal pain. Localized tenderness was observed in the upper right quadrant. Upon admission, hypoxia developed with a PaO2 of 66.7 mmHg under oxygen therapy. Abdominal contrast-enhanced computed tomography (CT) imaging revealed a perforated peptic ulcer with free gas and ascites. Emergency laparoscopic surgery was performed safely using a customized port position. DISCUSSION: Patients with scoliosis are prone to respiratory dysfunction, increasing their risk of life-threatening complications from peptic ulcer perforation. Early treatment is crucial in such cases. Meticulous perioperative management, appropriate port placement, and close communication with the anesthesiologist were key factors enabling emergency surgery in this high-risk patient, even if preoperative examinations could not be sufficiently conducted. Port insertion from the lower abdomen helped overcome anatomical limitations. CONCLUSION: Emergency laparoscopic surgery can be a viable option for patients with severe scoliosis and perforated peptic ulcers. Prompt decision-making, seamless perioperative management with the anesthesiologist, and tailored port placement to avoid intra-abdominal interference are essential for safe and effective procedures.