Perforation of a duodenal ulcer allows egress of gastric and duodenal contents into the peritoneal cavity with a resulting initial chemical peritonitis. If there is continuing leakage of gastroduodenal contents, bacterial contamination of the peritoneal cavity can occur.

Complications

• Internal bleeding. Bleeding can occur as slow blood loss that leads to anemia or as severe blood loss that may require hospitalization or a blood transfusion.
• A hole (perforation) in your stomach wall.
• Obstruction.
• Gastric cancer.

Perforated peptic ulcer (PPU) is relatively rare, but life-threatening with the mortality varying from 10% to 40% [2, 4–6].

Symptoms of a perforated ulcer may include:

• Sudden, severe pain in the belly (abdomen), usually in the upper abdomen.
• Pain spreading to the back or shoulder.
• Upset stomach (nausea) or vomiting.
• Lack of appetite or feeling full.
• Swollen belly or feeling bloated.

Duodenal perforation is a rare, but potentially life-threatening injury. Multiple etiologies are associated with duodenal perforations such as peptic ulcer disease, iatrogenic causes and trauma.

Ulcers can be treated with a surgical procedure called Omental patching. Omental patching is a surgical procedure for treating perforated ulcers. It is also called a Graham patch after the surgeon who first performed this technique. This procedure uses a patch of the omentum to repair the injury because it is durable.

A hole in the stomach or duodenum is called a perforation. This is a medical emergency. The most common cause of ulcers is infection of the stomach by bacteria called Helicobacter pylori (H pylori). Most people with peptic ulcers have these bacteria living in their digestive tract.

Overall 30-day mortality from perforated peptic ulcer was 25.3%, but it increased from 8.9% among patients younger than 65 years to respectively 28.5% and 46.0% among patients aged 65–79 years and 80+ years (table 2).

Perforation of the duodenum with spillage of intraluminal contents into the peritoneal cavity causes acute chemical peritonitis. This is followed by a systemic inflammatory response syndrome (SIRS), which can progress to secondary bacterial peritonitis and sepsis.

Attention to nutrition in the postoperative period is important to improve the health status of the patients and ensure adequate healing. Pain, swelling, and bruising is normal in the postoperative period and usually resolves within two weeks. Complete recovery can take four to six weeks.

The continuing problem with perforated duodenal ulcer stands in contrast to the fall in admissions for uncomplicated duodenal ulcers noted since the 1970’s and largely attributed to the introduction of H2antagonists (Grade C).

The most common complications include bleeding, perforation of the stomach or duodenal walls, and obstruction of the digestive tract. As an ulcer erodes the muscles of the stomach or duodenal wall, blood vessels may also be damaged, which causes the bleeding.

A perforated ulcer can cause peritonitis, an inflammation of the abdominal cavity and wall. The symptoms of a perforated ulcer include sudden, sharp, severe pain. Immediate hospitalization and surgery are usually required. 3  Ulcers located at the end of the stomach where the duodenum is attached may cause swelling and scarring.

Complications of Peptic Ulcers 1 Bleeding. As an ulcer erodes the muscles of the stomach or duodenal wall, blood vessels may also be damaged, which causes the bleeding. 2 Perforation. Sometimes an ulcer eats a hole in the wall of the stomach or duodenum. 3 Narrowing and Obstruction. 4 Causes.