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.
| 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 |
Signs and symptoms
editA 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]
Causes
editCauses include alcohol, smoking, consuming highly acidic foods and beverages (such as coffee), and nonsteroidal anti-inflammatory drugs (NSAIDs).[2]
Diagnosis
editThe 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
editTreatment generally requires immediate surgery.[5]
Prognosis
editPerforated 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
edit- 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]
- Steve Wright (1954–2024, aged 69) died from a stomach ulcer rupture on 12 February 2024.[11]
References
edit- ^ Stern, Evan; Sugumar, Kavin; Journey, Jonathan D. (2019), "Peptic Ulcer Perforated", StatPearls, StatPearls Publishing, PMID 30855910, retrieved 2019-10-30
- ^ a b Svanes C (2000). "Trends in perforated peptic ulcer: incidence, etiology, treatment, and prognosis". World J Surg. 24 (3): 277–83. doi:10.1007/s002689910045. PMID 10658061. S2CID 1922972.
- ^ "Peptic ulcers – treatment". Retrieved 2008-01-21.
- ^ "Surgical-tutor.org.uk – a free online surgical resource". Archived from the original on 2003-02-17. Retrieved 2003-02-17.
- ^ "Stomach ulcer – Better Health Channel".
- ^ Christensen, S.; Riis, A.; Nørgaard, M.; Sørensen, H. T.; Thomsen, R. W. (2007). "Short-term mortality after perforated or bleeding peptic ulcer among elderly patients: a population-based cohort study". BMC Geriatrics. 7: 8. doi:10.1186/1471-2318-7-8. PMC 3225863. PMID 17439661.
- ^ "Internet Archive Search: creator:"Preston, Thomas, 1860–1900"". recall.archive.org.
- ^ Gene Vincent
- ^ "Barbara Bush hospitalized".
- ^ "Palmer-Tomkinson 'died due to ulcer'". BBC News. 15 February 2017. Retrieved 15 February 2017.
- ^ "Steve Wright: BBC DJ died from stomach ulcer rupture".