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 sloughin ...

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 Digestion, digestive system that leads from the mouth to the anus. The tract is the largest of the body's systems, after the cardiovascula ...

(e.g., the

stomach The stomach is a muscular, hollow organ in the upper gastrointestinal tract of Human, humans and many other animals, including several invertebrates. The Ancient Greek name for the stomach is ''gaster'' which is used as ''gastric'' in medical t ...

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 contain Organ (anatomy), organs. It is a part of the abdominopelvic cavity. It is located below the thoracic cavity, and above the pelvic cavity. Its dome-shaped roo ...

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 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 tract is the largest of the body's systems, after the cardiovascular system. T ...

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 combusted, and the resulting smoke is typically inhaled to be tasted and absorbed into the bloodstream of a person. Most commonly, the substance used is the dried leaves of the tobacco plant, whi ...

, consuming highly acidic foods and beverages (such as

coffee Coffee is a beverage brewed from roasted, ground coffee beans. Darkly colored, bitter, and slightly acidic, coffee has a stimulating effect on humans, primarily due to its caffeine content, but decaffeinated coffee is also commercially a ...

), and

nonsteroidal anti-inflammatory drug Non-steroidal anti-inflammatory drugs (NSAID) are members of a Indication (medicine), therapeutic drug class which Analgesic, reduces pain, Anti-inflammatory, decreases inflammation, Antipyretic, decreases fever, and Antithrombotic, prevents bl ...

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 (also known in many languages as Röntgen radiation) is a form of high-energy electromagnetic radiation with a wavelength shorter than those of ultraviolet rays and longer than those of gamma rays. Roughly, X-rays have a wavelength ran ...

(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, Flagellum#bacterial, flagellated, Bacterial cellular morphologies#Helical, helical bacterium. Mutants can have a rod or curved rod shape that exhibits l ...

''.

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 (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'Antonguella (May 6, 1895 – August 23, 1926), known professionally as Rudolph Valentino and nicknamed The Latin Lover, was an Italian actor who starred in several well-known sile ...

(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 journalist, novelist, poet, and short-story writer. He was born in British Raj, British India, which inspired much ...

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

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

(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 Saxophone, saxophonist, bandleader, and composer. Parker was a highly influential soloist and leading figure in the development of beb ...

(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. *

J. R. R. Tolkien John Ronald Reuel Tolkien (, 3 January 1892 – 2 September 1973) was an English writer and philologist. He was the author of the high fantasy works ''The Hobbit'' and ''The Lord of the Rings''. From 1925 to 1945, Tolkien was the Rawlinson ...

(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. *

Tara Palmer-Tomkinson Tara Claire Palmer-Tomkinson (23 December 1971 – 8 February 2017) was an English socialite and television personality. She appeared in several television shows, including the reality programme ''I'm a Celebrity...Get Me Out of Here! (British ...

(1971–2017, aged 45) had a perforated ulcer and died on February 8, 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