What is a Perforated Peptic Ulcer?

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  • Written By: Dulce Corazon
  • Edited By: Jenn Walker
  • Last Modified Date: 08 September 2019
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A perforated peptic ulcer is one of the few complications of peptic ulcer disease (PUD). PUD is a condition where stomach acids erode the lining of the duodenum, the first section of the small intestines, or of the stomach; this condition often leads to the development of ulcers or sores. If not treated, the constant production of stomach acids, which are necessary for the digestion of foods, will eventually create a hole in the stomach or intestinal lining, often resulting in a perforated peptic ulcer.

There are several factors leading to PUD. An infection with a bacteria known as Helicobacter pylori is most often the leading cause. Other factors include habitual intake of non-steroidal anti-inflammatory drugs (NSAIDs), frequent consumption of highly acidic foods, alcoholism and cigarette smoking. A disorder known as Zollinger-Ellison syndrome, which is a tumor stimulating excessive production of stomach acid, may also contribute to the disease. Symptoms associated with PUD include burning abdominal pain, especially after eating a meal, vomiting and sometimes melena, which indicates the presence of blood in the stool and is often a result of a bleeding ulcer in the stomach.


Once a perforated peptic ulcer occurs, contents from the stomach or intestines often escape to the space in the abdomen known as the peritoneal cavity. The presence of these materials in the peritoneal cavity is generally toxic to the body and may cause peritonitis, or inflammation in the walls of the cavity. When peritonitis occurs, it is usually seen as a medical emergency needing immediate medical or surgical intervention. Symptoms of peritonitis include sudden abdominal pain which progresses in severity, fever, nausea, loss of appetite and vomiting. Patients are also often seen in a fetal position due to the pain and their abdomen is usually very hard when touched.

Diagnostic exams, such as X-rays of the chest and abdomen, are often done in order to detect the location of the perforation and the extent of damage to the gastrointestinal tract (GIT). A gastroenterologist, a medical doctor specializing in the treatment of patients with diseases in the GIT, is often the one evaluating patients with a perforated peptic ulcer. After a thorough examination, he usually provides antibiotics and other necessary medications, and may also refer the patient to surgery. Gastrointestinal tract surgeons usually perform an exploratory laparotomy to open the abdomen and repair the perforation. A small tissue sample is also frequently removed during surgery to be sent to the laboratory to be studied for the presence of any malignancy.


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Post 3

I was operated on two months ago for a perforated ulcer in my duodenum. I never had any gastrointestinal problems my whole life except this. The culprit seems to be NSAID drugs that I have been taking for the past couple of years for my arthritis.

My doctor said that he has been seeing more and more elderly patients with perforated duodenal ulcers lately. He said that when he first started his career, it was seen in younger patients and usually males. But I guess with the more widespread use of NSAIDs now, the elderly are suffering from this a lot more than usual.

I was also one of the few people who had no symptoms before the ulcer perforated. The pain came about very suddenly, so there wasn't anything I could do to prevent it.

Post 2
@MikeMason-- One of my coworkers was hospitalized because of a perforated peptic ulcer recently. She wasn't even aware of what's going on and found out by chance!

She had been having an upset stomach for the past couple of days, as well as bloating and feeling really hungry. She was shocked when they told her at the doctor's office that they have to operate on her as soon as possible because she has a perforated peptic ulcer.

I guess this condition can sneak up on you before you even realize it sometimes. She's fine now after surgery. She just has to follow a peptic ulcer diet and takes a medication to inhibit too much acid production in her stomach.

Post 1

Peptic ulcers are horrible. I used to have them because of a helicobacter pylori infection. I had all the symptoms the article mentioned. I was nauseated all the time, had horrible stomach pains and cramps and vomited soon after eating.

I was even hospitalized a couple of times because of it. Both times, they took an x-ray of my stomach at the hospital to see if the ulcers had perforated or not. Thankfully, they hand't and I was basically sent home and told to take over-the -counter medications.

Perforation of a peptic ulcer is so dangerous. Treatment of peptic ulcers are easier and less dangerous. I don't understand why doctors don't do more to prevent perforation from happening by treating the ulcers before it's too late.

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