Perforation is one of the most serious complications of peptic ulcers. When an ulcer penetrates the wall of the stomach or duodenum causing perforation, it can cause bleeding and abdominal pain. There are several different consequences of perforation. Acute perforation can lead to acute peritonitis, shock or, in severe cases, life-threatening haemorrhage if not treated promptly. Chronic perforations can penetrate surrounding organs, including the liver, spleen and pancreas, and form fistulas, such as biliary fistulas through the common bile duct and intestinal fistulas through the intestinal duct.