A perforated ulcer is a condition in which an untreated

ulcer An ulcer is a discontinuity or break in a bodily membrane that impedes normal function of the affected organ. According to Robbins's pathology, "ulcer is the breach of the continuity of skin, epithelium or mucous membrane caused by sloughing o ...

has burned through the mucosal wall in a segment of the

gastrointestinal tract The gastrointestinal tract (GI tract, digestive tract, alimentary canal) is the tract or passageway of the digestive system that leads from the mouth to the anus. The GI tract contains all the major organs of the digestive system, in humans and ...

(e.g., the

stomach The stomach is a muscular, hollow organ in the gastrointestinal tract of humans and many other animals, including several invertebrates. The stomach has a dilated structure and functions as a vital organ in the digestive system. The stomach i ...

or colon) allowing gastric contents to leak into the

abdominal cavity The abdominal cavity is a large body cavity in humans and many other animals that contains many organs. It is a part of the abdominopelvic cavity. It is located below the thoracic cavity, and above the pelvic cavity. Its dome-shaped roof is th ...

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 The gastrointestinal tract (GI tract, digestive tract, alimentary canal) is the tract or passageway of the digestive system that leads from the mouth to the anus. The GI tract contains all the major organs of the digestive system, in humans an ...

wall. The first symptom of a perforated peptic ulcer is usually sudden, severe, sharp pain in the abdomen. 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 Smoking is a practice in which a substance is burned and the resulting smoke is typically breathed in to be tasted and absorbed into the bloodstream. Most commonly, the substance used is the dried leaves of the tobacco plant, which have b ...

, consuming highly acidic foods and beverages (such as

coffee Coffee is a drink prepared from roasted coffee beans. Darkly colored, bitter, and slightly acidic, coffee has a stimulating effect on humans, primarily due to its caffeine content. It is the most popular hot drink in the world. Seeds of ...

), and

nonsteroidal anti-inflammatory drug Non-steroidal anti-inflammatory drugs (NSAID) are members of a therapeutic drug class which reduces pain, decreases inflammation, decreases fever, and prevents blood clots. Side effects depend on the specific drug, its dose and duration o ...

s (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 An X-ray, or, much less commonly, X-radiation, is a penetrating form of high-energy electromagnetic radiation. Most X-rays have a wavelength ranging from 10 picometers to 10 nanometers, corresponding to frequencies in the range 30&nb ...

(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. Many perforated ulcers have been attributed to the bacterium ''

Helicobacter pylori ''Helicobacter pylori'', previously known as ''Campylobacter pylori'', is a gram-negative, microaerophilic, spiral (helical) bacterium usually found in the stomach. Its helical shape (from which the genus name, helicobacter, derives) is thoug ...

''.

Treatment

Treatment generally requires immediate surgery.

Prognosis

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

Notable cases

Richard Pankhurst Richard Marsden Pankhurst (1834 – 5 July 1898) was an English barrister and socialist who was a strong supporter of women's rights. Early life Richard Pankhurst was the son of Henry Francis Pankhurst (1806–1873) and Margaret Marsden (1 ...

(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. *

Rudolph Valentino Rodolfo Pietro Filiberto Raffaello Guglielmi di Valentina d'Antonguolla (May 6, 1895 – August 23, 1926), known professionally as Rudolph Valentino and nicknamed The Latin Lover, was an Italian actor based in the United States who starred ...

(1895–1926, aged 31) had a perforated ulcer and died on August 23, 1926. *

Rudyard Kipling Joseph Rudyard Kipling ( ; 30 December 1865 – 18 January 1936)'' The Times'', (London) 18 January 1936, p. 12. was an English novelist, short-story writer, poet, and journalist. He was born in British India, which inspired much of his work. ...

(1865–1936, aged 70) died of perforated duodenal ulcer on 18 January 1936. *

James Joyce James Augustine Aloysius Joyce (2 February 1882 – 13 January 1941) was an Irish novelist, poet, and literary critic. He contributed to the Modernism, modernist avant-garde movement and is regarded as one of the most influential and important ...

(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 Charles Parker Jr. (August 29, 1920 – March 12, 1955), nicknamed "Bird" or "Yardbird", was an American jazz saxophonist, band leader and composer. Parker was a highly influential soloist and leading figure in the development of bebop, a form ...

(1920–1955, aged 34) had a perforated ulcer, and died on March 12, 1955. *

Albert Blithe Albert Blithe (June 25, 1923 – December 17, 1967) was an American career soldier who served as a private first class with Easy Company, 2nd Battalion, 506th Parachute Infantry Regiment, in the 101st Airborne Division during World War II. Blit ...

(1923–1967, aged 44) had a perforated ulcer and died on December 17, 1967. *

Gene Vincent Vincent Eugene Craddock (February 11, 1935 – October 12, 1971), known as Gene Vincent, was an American musician who pioneered the styles of rockabilly and rock and roll. His 1956 top ten hit with his backing band the Blue Caps, " Be-Bop-a-Lula ...

(1935–1971, aged 36) had a ruptured stomach ulcer and died on October 12, 1971. * 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 Ian Mackendrick Hendry (13 January 1931 – 24 December 1984) was a British actor. He worked on several British TV series of the 1960s and 1970s, including the lead in the first series of '' The Avengers'' and '' The Lotus Eaters'', and played ...

(1931—1984, aged 53) died of a stomach haemorrhage in London. *

Gene Clark Harold Eugene Clark (November 17, 1944 – May 24, 1991) was an American singer-songwriter and founding member of the folk rock band the Byrds. He was the Byrds' principal songwriter between 1964 and early 1966, writing most of the band's best ...

(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 Philip Burnett Franklin Agee (; January 19, 1935 – January 7, 2008)Will Weissert"Ex-CIA Agent Philip Agee Dead in Cuba" Associated Press (sfgate.com), January 9, 2008. was a Central Intelligence Agency (CIA) case officer and writer of t ...

(1935–2008, aged 72) had a perforated ulcer and died on January 7, 2008. *

Barbara Bush Barbara Pierce Bush (June 8, 1925 – April 17, 2018) was First Lady of the United States from 1989 to 1993, as the wife of President George H. W. Bush, and the founder of the Barbara Bush Foundation for Family Literacy. She previously w ...

(1925-2018, aged 92) was treated for a perforated ulcer in November 2008. *

Tara Palmer-Tomkinson Tara Claire Palmer-Tomkinson (23 December 1971 – 8 February 2017), also known as T P-T, was an English socialite and television personality. She appeared in several television shows, including the reality programme '' I'm a Celebrity...Get Me ...

(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