1.In patients with acute perforation of the stomach and duodenum, 80% to 90% have a history of ulcer disease, and often have worsening symptoms of ulcer disease and recurrence before perforation. 2, abdominal pain is the most prominent symptom of ulcer disease perforation. When perforation occurs, the patient suddenly feels severe pain in the upper abdomen, which is persistent knife-like or tear-like pain, and can increase in paroxysms. The pain starts from the upper abdomen and spreads rapidly to the right lower abdomen and the whole abdomen, and about 1/3 of the patients have pain radiating to the right shoulder. 3, about half of the patients with ulcer perforation often reflexively cause nausea and vomiting, vomit is mostly food residues and gastric juice, mixed with bloody or coffee-like liquid, if the development of the disease leads to intestinal paralysis, the vomiting will be more serious. 4, the intense stimulation after perforation can often cause the patient irritable, pale, cold limbs, palpitations, sweating, temperature drop, pulse rate increase, blood pressure drop and other shock symptoms. After 1-5 hours of perforation, some patients may have different degrees of relief from the above symptoms due to increased peritoneal exudate, which dilutes the gastric contents flowing into the abdominal cavity, abdominal pain and abdominal muscle tension are reduced, and shock symptoms improve on their own, but the pressure pain is still obvious. At this time, it is easy to cause misdiagnosis or leakage. After 10-12 hours of perforation, with the absorption of peritoneal exudate and secondary bacterial infection, if not timely diagnosis and treatment, the patient can enter the late stage of peritonitis with chills, high fever, and even toxic intestinal paralysis, sepsis, septicemia, and eventually death due to toxic shock. Special note: elderly and frail patients react to and tolerate perforation differently than young and strong patients. Their abdominal pain symptoms are less obvious and intense, but vomiting and abdominal distension are heavier, and they are prone to shock, with faster progression and poor prognosis, so they must be highly alert.