Perforation Of Gastric And Duodenal Ulcers: Clinical Symptoms And Progression

Perforation of gastric and duodenal ulcers is a severe complication of peptic ulcer disease and one of the most common acute abdominal conditions requiring surgical intervention. The perforation often occurs suddenly, especially during the night, either on an empty stomach or shortly after a heavy meal. Patients typically experience a sudden, sharp, knife-like pain in the upper abdomen that rapidly spreads throughout the entire abdominal region.

Initial Symptoms And Physical Reactions

At the onset, the pain is so intense that patients may become pale, break out in cold sweats, and exhibit signs of tachycardia — a rapid, weak pulse — along with a drop in blood pressure. Nausea and vomiting are also commonly observed. As the digestive fluids leak from the stomach into the abdominal cavity, they may flow along the right paracolic gutter, causing referred pain in the right lower quadrant of the abdomen. In some cases, the discomfort may radiate to the shoulder area due to diaphragmatic irritation.

Progression Of Abdominal Pain And Fluid Accumulation

Initially, the intense pain may subside slightly as the body releases fluid into the abdominal cavity, which helps dilute the corrosive digestive enzymes. However, this relief is temporary. Within approximately six to eight hours after the perforation, bacterial proliferation begins, leading to the development of purulent peritonitis. As the infection progresses, the abdominal pain intensifies once again.

Potential For Septic Shock And Systemic Complications

The combination of strong chemical irritation, loss of extracellular fluid, and the absorption of bacterial toxins can lead to life-threatening septic shock. Given the rapid progression and severity of symptoms, timely diagnosis and immediate medical intervention are crucial. Without prompt treatment, the condition can quickly become fatal.

Predisposing Factors And Patient History

Most patients who experience perforation have a long-standing history of peptic ulcer disease. In the days leading up to the event, many report a worsening of typical ulcer symptoms such as burning stomach pain or indigestion. Common triggers include overeating, excessive fatigue, consumption of spicy or irritating foods, and the use of corticosteroids or other ulcer-inducing medications.