Acute perforation is a common and serious complication of gastric and duodenal ulcers. Nowadays, the incidence of ulcer perforation is on the rise, and the age of onset is getting older. However, duodenal ulcer perforation is mostly seen in the anterior wall of the bulb in male patients, and gastric perforation is mostly seen in the lesser curvature of the stomach in older women. A small number of patients are re-perforated ulcers. The etiology of acute perforation of gastroduodenal ulcers: The course of gastric and duodenal ulcers is a dynamic process that results from the interaction between the defense mechanisms of the gastroduodenal mucosa and injury factors. Recurrent episodes of ulcer disease and remission reflect the alternation of ulcerogenesis, development and healing processes. This long-term recurrent process destroys the histological structure of the gastroduodenal wall and is replaced by fibrous scarring, granulation tissue and necrotic tissue, which eventually penetrates the muscular and plasma layers to form acute perforation (anterior wall) or chronic penetrating ulcer (posterior wall). After acute perforation, gastroduodenal fluid and food enter the peritoneal cavity, causing chemical peritonitis. After a few hours, bacterial multiplication transforms into bacterial peritonitis, and after bacterial toxins are absorbed, the patient may develop toxic shock based on the original hypovolemia. Nowadays, acute gastroduodenal ulcer perforation is also found to be closely related to H. pylori. Clinical manifestations of acute perforation of gastroduodenal ulcer: previous history of ulcer disease, or in a few cases, no previous history of ulcer disease. A few days before the perforation ulcer disease symptoms aggravated, or mood swings, excessive fatigue and other triggers, suddenly occur at night after fasting or full stomach, acute subxiphoid, epigastric severe pain, tearing or knife-like pain, the patient can not tolerate, accompanied by pale, cold sweat, pulse rate, often accompanied by nausea, vomiting, pain soon spread to the whole abdomen. Sometimes. The stomach contents may flow down along the right paracolic sulcus and the right lower abdominal pain appears. Later, the abdominal pain may be slightly relieved by the dilution of a large amount of abdominal exudate. Later on, the abdominal pain may worsen again due to secondary bacterial infection. The patient’s expression is painful; supine position and reluctance to change position, abdominal breathing is weakened or disappeared, abdominal muscle tension is “plank-like” straight, there is pressure pain and rebound pain in the whole abdomen, pressure pain in the right upper abdomen is obvious, there is mobile turbid sound on percussion, the hepatic turbid boundary is narrowed or disappeared, intestinal sounds are obviously weakened or disappeared, on standing x-ray examination, 80% of patients with right subdiaphragm Free gas shadow is seen in 80% of patients in standing x-ray. Diagnosis of acute perforation of gastroduodenal ulcer: The diagnosis can be made on the basis of previous history of ulcer, sudden onset of severe and persistent epigastric pain that quickly turns into total abdominal pain, physical examination with signs of peritoneal irritation, narrowing of the hepatic turbinates, diminished or absent bowel sounds, and free gas under the diaphragm on x-ray. In case of doubt, laparotomy is feasible. The following conditions often lead to diagnostic difficulties: (1) no previous history of typical ulcers; (2) poor symptom description in elderly or pediatric patients. Signs are atypical; (3), fasting onset and small perforations with little leakage: (4), small perforations of posterior wall ulcers with leakage into the small omental sac; (5), very weak; (6), obese individuals; (7), use of analgesics after the onset of the disease; (8), no subdiaphragmatic free gas on X-ray. With the above conditions, symptoms and signs may not be typical and need to be differentiated from the following diseases when diagnosis is difficult: 1. Acute pancreatitis is also a sudden onset of severe pain in the upper abdomen, accompanied by vomiting and signs of peritoneal irritation. Acute pancreatitis is mostly left upper abdominal pain that radiates to the lower back, but there is no subdiaphragmatic free gas on X-ray, and serum amylase exceeds 500 Soxhlet units. 2. Acute cholecystitis is severe colic or continuous pain in the right upper abdomen with paroxysmal intensification, radiating to the right shoulder, accompanied by chills and fever. Positive signs are mainly concentrated in the right upper abdomen, manifested by local pressure pain and rebound pain, sometimes the enlarged gallbladder can be palpated, positive Murphy’s sign, ultrasound suggesting cholecystitis and/or gallbladder stones. 3.Leakage flow of acute appendicitis ulcer perforation to the right lower abdomen, right lower abdominal pain and pressure pain and rebound pain occur, which can be confused with acute appendicitis. However, the general symptoms of acute appendicitis are not as severe as ulcer perforation, and there is no pneumoperitoneum. The differential diagnosis relies on the fact that the respective primary signs remain limited to the focal area. x-ray examination helps to differentiate. Treatment of acute perforation of gastroduodenal ulcer: 1. Non-surgical treatment is indicated for patients with fasting perforation who are in good general condition, young, without lesions in the main organs, with a short history of ulcer, and with mild symptoms and signs, and can be treated with gastrointestinal decompression, auxiliary fluids and antibiotics as appropriate. If the condition worsens after 6-8 hours of non-surgical treatment, the patient should be immediately switched to surgical treatment. For patients who recover from non-surgical treatment, gastroscopy should be performed to exclude gastric cancer, and those who are positive for Helicobacter pylori should be treated with additional bacterium removal and acid control agents. 2.Surgical treatment has two types of surgical methods: simple perforation and suture and complete ulcer surgery. The advantage of simple perforation suture is easy to operate, short operation time, less dangerous, but the disadvantage is that 2/3 patients, later because the ulcer is not healed and perform a second complete surgery. The advantage of complete ulcer surgery is that it solves both perforation and ulcer problems in one operation and eliminates the need for a second operation in the future, but it is more complicated and more dangerous. The choice should be based on the patient’s general condition, intra-abdominal inflammation and ulcerative lesions. It is generally accepted that if the patient is in good general condition, has a history of pyloric obstruction or bleeding, the perforation is within 12 hours, and the intra-abdominal inflammation and edema of the gastroduodenal wall are mild. Radical surgery can be performed. Otherwise, perforation suturing can be performed. Radical surgery includes: major gastrectomy, gastrotomy plus sinus resection for duodenal ulcer perforation, or sutured perforation followed by enterotomy plus gastrojejunostomy, or highly selective vagotomy, etc. In recent years, as the age of patients with perforated duodenal ulcers increases, the risk of surgery increases, so the question arises whether to perform complete treatment of perforated ulcers along with suturing of perforated ulcers. The three risk factors for patients with perforated ulcers are severe disease of the major organs, preoperative shock, and perforation for more than 24 hours. Recently, some hospitals have been performing TV laparoscopic suturing of large omentum-covered perforations. Patients treated with ulcer perforation sutures should be given acid suppressants plus H. pylori eradication therapy until gastroscopic confirmation of ulcer healing and eradication of H. pylori.