Perforated ulcer
Other names	Ruptured ulcer
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.
Specialty	Gastroenterology
Symptoms	Abdominal pain, vomiting, nausea
Complications	Bowel perforation, sepsis, gastrointestinal hemorrhage
Usual onset	Sudden
Risk factors	Untreated peptic ulcer
Treatment	Immediate surgery

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 causes perforation of the intestine wall. The first symptom of a perforated peptic ulcer is usually sudden, severe, sharp pain in the abdomen.^[1] 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.

Causes

Causes include alcohol, smoking, consuming highly acidic foods and beverages (such as coffee), and nonsteroidal anti-inflammatory drugs (NSAIDs).^[2]

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.^[3] Many perforated ulcers have been attributed to the bacterium Helicobacter pylori.^[4]

Treatment

Treatment generally requires immediate surgery.^[5]

Prognosis

Perforated peptic ulcer is a serious condition with an overall reported mortality of 5%–25%, rising to as high as 50% with age.^[6] The incidence of perforated ulcer is steadily declining, though there are still incidents where it occurs.^[2]

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.^[7]
• 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.
• Gene Vincent (1935–1971, aged 36) had a ruptured stomach ulcer and died on October 12, 1971. ^[8]
• 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.^[9]
• Tara Palmer-Tomkinson (1971–2017, aged 45) had a perforated ulcer and died on February 8, 2017.^[10]

References

Further reading

• http://healthgate.partners.org/browsing/browseContent.asp?fileName=11628.xml&title=Peptic%20Ulcer