A perforated ulcer is generally a perforation of a peptic ulcer. Perforation is one of the complications of ulcer disease. When the ulcer develops deeper, that is, when the ulcer surface is deeper, it can penetrate the intestinal wall of the stomach or duodenum, causing three main consequences of peptic perforation: first, the ulcer perforation breaks into the abdominal cavity causing the manifestation of diffuse peritonitis, where the patient suddenly has increased abdominal pain and it persists. At this time, the pain may be epigastric and subsequently extend to the whole abdomen. Some patients may show signs of infectious shock. Second, perforated ulcers can penetrate into adjacent substantive organs, such as the liver, pancreas, or spleen. Clinically also called penetrating ulcers, such ulcers occur more slowly and the original abdominal pain pattern of peptic ulcers becomes very persistent and painful. Third, penetration into the cavity of the organ forms a fistula, or fistula tract. For example, ulcers in the duodenal bulb can penetrate the common bile duct. Gastric ulcers can penetrate the duodenum. This time can be determined by barium meal or CT examination.
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