Perforated Peptic Ulcer

Perforated peptic ulcer is a dangerous complication of ulcers of the stomach and duodenum. Untreated perforation is usually a fatal condition.


The cause is an untreated peptic ulcer disease. Without proper treatment, the peptic ulcer may grow, deepen and expand to the adjacent tissue. At some point, the wall of the gastrointestinal tract is damaged to such extent that it bursts.


The perforation causes a violent and severe abdominal pain, which is initially located in the upper abdomen, but later it moves downwards as the stomach content leaks into the abdominal cavity. The abdominal wall stiffens like a wooden board and the palpation and percussion are both painful. Peritonitis quickly emerges causing the intestines to stop, the so-called paralytic ileus. Fully developed peritonitis is associated with abdominal pain, fever, general deterioration and gradually turns into septic condition and cardiovascular shock with destabilization of the respiratory and circulatory system ultimately resulting in death.


The patient should be carefully physically examined, in ideal case by a surgeon. Medical history of a peptic ulcer is also handy to state the diagnosis correctly. X-ray of the abdomen is essential as it shows air in the abdominal cavity (so-called pneumoperitoneum).


Ruptured peptic ulcer is usually evaluated as a condition of emergency that requires a surgical intervention aiming to sew the ruptured wall of the gastrointestinal tract. In some cases, more aggressive approach is needed and the surgeons may remove part of the stomach or duodenum. Postsurgical monitoring of vital functions, prevention of shock and antibiotics administration are also necessary.


Jiri Stefanek, MD  Author of texts: Jiri Stefanek, MD
 Sources: basic text sources