Atypical Presentation of Gastric Perforation in an Octogenarian Masquerading as a Near-Fall: A Case Report.

An older woman with mild frailty presented after a near-fall when her knee gave way whilst mobilising with a walking frame. She was unable to rise from the floor but was otherwise asymptomatic, with no gastrointestinal symptoms. Examination showed no injury and a soft non-tender abdomen. Initial investigations demonstrated metabolic acidosis with raised ketones, and alcoholic ketoacidosis was considered. However, persistent acidosis and a fall in haemoglobin prompted further investigation. Chest radiography showed no free subdiaphragmatic air, but computed tomography confirmed gastric perforation. Following multidisciplinary review, operative management was not pursued due to frailty and limited physiological reserve. She was transferred to the palliative care ward and died shortly afterwards. This case highlights atypical presentation of acute emergencies in frail older adults, the risk of anchoring bias, and the importance of medication review.