limits, corrected coagulation times were requested which were slightly elevated and prolonged to which it was decided to request a reserve of four units of plasma cross samples.Computed axial tomography of the abdomen showed marked pneumoperitoneum in the upper abdomen.Free fluid from subphrenic spaces to the pelvis (Figs 1 to 3).Given the high diagnostic possibility of perforated peptic ulcer, risk of instability, and acute abdomen, the patient was taken to surgery for laparoscopic surgery. Surgical TechniqueThe patient is under general anesthesia and continuous monitoring.The patient is placed in the French position.Pneumoperitoneum 14-15 mm Hg through 12 mm umbilical trocar placed with Hasson open technique.Three additional trocars were placed under direct laparoscopic vision (2 of 5 mm in the right flank, anterior axillary line, and midclavicular and another of 12 mm in the left flank). clinical caSe DeScripTionA 54-year-old male patient of Danish nationality, a pensioner with no known history of drug allergies, who, as a risk factor, presents anabolic abuse in the plan to increase muscle mass over physical exertion that conditioned the daily intake of nonsteroidal anti-inflammatory drugs, who decides to consult for 2 days of evolution of high-intensity abdominal pain 10/10 in analog verbal scale that starts in the epigastrium and radiates in the band in upper hemiabdomen that then migrated to right iliac fossa and right flank that does not improve after intake of analgesics usually consumed by the patient, associated with nausea, multiple emetic episodes, intolerance to oral intake of solids and liquids, which limits the daily activities of the patient who was a tourist in the city.On physical examination, the patient was in regular general condition, very algic, with vital signs that showed sinus tachycardia, blood pressure figures with a tendency to high predominantly systolic, tachypnea with use of accessory muscles, complete body and facial flushing, alert and oriented in the three spheres, afebrile with conscious grade II dehydration, abdomen with voluntary and involuntary defense, painful to superficial and deep palpation in the upper abdomen and exacerbated in the right iliac fossa, which limits its complete assessment, signs of peritoneal irritation, eutrophic symmetrical extremities, distal pulses present, no evidence of vascular or neurological deficit, capillary filling <3 seconds.Laboratory tests showed leukocytosis of 58.05, with 93% neutrophils, hemoglobin 15.6, hematocrit 42.9, platelets 4,72,000, no ionic alterations, renal function with creatinine elevation of 2.74 with urea nitrogen 30.44, prolonged coagulation times with partial thromboplastin time 9 seconds longer than control, prothrombin time twice its reference value with INR 1.98, amylase not elevated near the upper limit of normality, lactic acid at 1.30, arterial gases with mixed alkalosis, transaminases within normal