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.
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.
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.[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.[citation needed]
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.
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. [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]
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