Perforated ulcer

{{Infobox medical condition (new)

| name = {{PAGENAME}}

| synonym = Ruptured ulcer

| image = DU 2.jpg

| caption = Endoscopic image of a posterior wall duodenal ulcer with a clean base, which is a common cause of upper gastrointestinal hemorrhage and could potentially lead to perforation.

| pronounce =

| field =

| symptoms = Abdominal pain, vomiting, nausea

| onset = Sudden

| duration =

| causes =

| risks = Untreated peptic ulcer

| complications = Bowel perforation, sepsis, gastrointestinal hemorrhage

| diagnosis =

| differential =

| prevention =

| treatment = Immediate surgery

| medication =

| frequency =

| deaths =

}}

A perforated ulcer is a condition in which an untreated ulcer has burned through the mucosal wall in a segment of the gastrointestinal tract (e.g., the stomach or colon) allowing gastric contents to leak into the abdominal cavity.

Signs and symptoms

A perforated ulcer can be grouped into a stercoral perforation which involves a number of different things that cause perforation of the intestine wall. The first symptom of a perforated peptic ulcer is usually sudden, severe, sharp pain in the abdomen.{{Citation|last1=Stern|first1=Evan|title=Peptic Ulcer Perforated|date=2019|url=http://www.ncbi.nlm.nih.gov/books/NBK538326/|work=StatPearls|publisher=StatPearls Publishing|pmid=30855910|access-date=2019-10-30|last2=Sugumar|first2=Kavin|last3=Journey|first3=Jonathan D.}} The pain is typically at its maximum immediately and persists. It is characteristically made worse by any movement, and greatly intensifies with coughing or sneezing.{{fact|date=August 2022}}

Causes

Causes include alcohol, smoking, consuming highly acidic foods and beverages (such as coffee), and nonsteroidal anti-inflammatory drugs (NSAIDs).

Diagnosis

The ulcer is known initially as a peptic ulcer before the ulcer burns through the full thickness of the stomach or duodenal wall. A diagnosis is made by taking an erect abdominal/chest X-ray (seeking air under the diaphragm). This is in fact one of the very few occasions in modern times where surgery is undertaken to treat an ulcer.{{cite web |url=http://www.netdoctor.co.uk/diseases/facts/pepticulcertreatment.htm |title=Peptic ulcers – treatment |access-date=2008-01-21 }} Many perforated ulcers have been attributed to the bacterium Helicobacter pylori.{{Cite web |url=http://www.surgical-tutor.org.uk/default-home.htm?system%2Fabdomen%2Fperforated_peptic.htm~right |title=Surgical-tutor.org.uk – a free online surgical resource |access-date=2003-02-17 |archive-url=https://web.archive.org/web/20030217075337/http://www.surgical-tutor.org.uk/default-home.htm?system%2Fabdomen%2Fperforated_peptic.htm~right |archive-date=2003-02-17 |url-status=dead }}

Treatment

Treatment generally requires immediate surgery.{{Cite web|url=http://www.betterhealth.vic.gov.au/BHCV2/bhcarticles.nsf/pages/Stomach_ulcer?OpenDocument|title=Stomach ulcer – Better Health Channel}}

Prognosis

Perforated peptic ulcer is a serious condition with an overall reported mortality of 5%–25%, rising to as high as 50% with age.{{cite journal |title=Short-term mortality after perforated or bleeding peptic ulcer among elderly patients: a population-based cohort study |year=2007 |pmc=3225863 |last1=Christensen |first1=S. |last2=Riis |first2=A. |last3=Nørgaard |first3=M. |last4=Sørensen |first4=H. T. |last5=Thomsen |first5=R. W. |journal=BMC Geriatrics |volume=7 |page=8 |doi=10.1186/1471-2318-7-8 |pmid=17439661 |doi-access=free }} The incidence of perforated ulcer is steadily declining, though there are still incidents where it occurs.{{cite journal |author=Svanes C |title=Trends in perforated peptic ulcer: incidence, etiology, treatment, and prognosis |journal=World J Surg |volume=24 |issue=3 |pages=277–83 |year=2000 |pmid=10658061 |doi=10.1007/s002689910045|s2cid=1922972 }}

Notable cases

Richard Pankhurst (1835–1897, aged 62) had a perforated ulcer and died on 5 July 1897.
Thomas Preston (1860–1900, aged 39 or 40) had a perforated ulcer and died in 1900.{{Cite web|url=http://recall.archive.org/search.php?query=creator:%22Preston,+Thomas,+1860-1900%22|title=Internet Archive Search: creator:"Preston, Thomas, 1860–1900"|website=recall.archive.org}}
Rudolph Valentino (1895–1926, aged 31) had a perforated ulcer and died on August 23, 1926.
Rudyard Kipling (1865–1936, aged 70) died of perforated duodenal ulcer on 18 January 1936.
James Joyce (1882–1941, aged 58) had a perforated ulcer and died on January 13, 1941, in Zürich.
Guy Rochon Owen (1913–1952, aged 38) had a perforated ulcer, and died on April 21, 1952.
Charlie Parker (1920–1955, aged 34) had a perforated ulcer, and died on March 12, 1955.
Albert Blithe (1923–1967, aged 44) had a perforated ulcer and died on December 17, 1967.
Pavel Belyayev (1925—1970, aged 44) had a perforated duodenal ulcer that progressed to peritonitis following surgical complications, and died on January 10, 1970.
Gene Vincent (1935–1971, aged 36) had a ruptured stomach ulcer and died on October 12, 1971. Gene Vincent
J. R. R. Tolkien (1892–1973, aged 81) had a perforated ulcer and died on September 2, 1973.
Count Dante (1939–1975, aged 36) died of internal hemorrhaging caused by a bleeding ulcer, on May 25, 1975.
Ian Hendry (1931—1984, aged 53) died of a stomach haemorrhage in London.
Gene Clark (1944–1991, aged 46) had perforated ulcer and died on May 24, 1991.
Doug Hepburn (1926–2000, aged 74) had a perforated ulcer and died on November 22, 2000.
Philip Agee (1935–2008, aged 72) had a perforated ulcer and died on January 7, 2008.
Barbara Bush (1925–2018, aged 92) was treated for a perforated ulcer in November 2008.{{Cite web|url=https://news.yahoo.com/s/ap/us_barbara_bush_hospitalized|title=Barbara Bush hospitalized}}
Tara Palmer-Tomkinson (1971–2017, aged 45) had a perforated ulcer and died on February 8, 2017.{{cite news|title=Palmer-Tomkinson 'died due to ulcer'|url=https://www.bbc.co.uk/news/uk-england-london-38983931|access-date=15 February 2017|work=BBC News|date=15 February 2017}}
Steve Wright (1954–2024, aged 69) died from a stomach ulcer rupture on 12 February 2024.{{Cite web|url=https://www.bbc.co.uk/news/articles/cd1jlvp77y4o|title=Steve Wright: BBC DJ died from stomach ulcer rupture}}