Duodenal Ulcer Complications: Understanding the Most Common Risks

Duodenal ulcers, particularly those located in the duodenal bulb, can lead to several serious complications if left untreated. The most common of these complications include gastrointestinal bleeding, pyloric obstruction, and perforation. Each of these conditions presents unique symptoms and requires specific medical interventions.

Gastrointestinal Bleeding

Bleeding is the most frequent complication associated with duodenal bulb ulcers. Many patients seek medical attention due to symptoms related to gastrointestinal bleeding. Common signs include anemia, melena (black, tarry stools), fatigue, and dizziness. In some cases, bleeding may be chronic and result in significant blood loss over time.

Even small amounts of blood loss can be detected—approximately 5ml may result in a positive fecal occult blood test. When bleeding reaches about 50ml, visible melena typically occurs. As the volume of blood loss increases, patients may experience hematemesis (vomiting of blood) when acute blood loss exceeds 400–500ml. Severe bleeding exceeding 1,000ml in a short time can lead to life-threatening symptoms such as rapid heart rate, low blood pressure, cold sweats, and pallor—indicative of circulatory collapse.

Pyloric Obstruction

Some patients with recurrent duodenal ulcers may develop pyloric obstruction after several years of repeated episodes. This condition often presents with symptoms such as nausea, vomiting, and an inability to digest food properly. The vomitus may contain undigested food from the previous night, a condition known as "overnight gastric retention."

In some cases, physicians may detect a "splash sound" in the upper abdomen, suggesting gastric distention with retained contents. While some patients respond well to medical treatment—including Helicobacter pylori eradication, acid suppression, and mucosal protection—others may require endoscopic or surgical intervention to relieve the obstruction.

Perforation: A Medical Emergency

Perforation is the most severe complication of duodenal ulcers and requires immediate surgical intervention. It occurs when the ulcer erodes completely through the wall of the duodenum, allowing gastric contents to leak into the abdominal cavity. This can lead to peritonitis and sepsis if not promptly treated.

Patients experiencing perforation typically present with sudden, severe abdominal pain and signs of shock. Emergency surgery is often necessary to repair the perforation and prevent further complications. Early diagnosis and treatment of duodenal ulcers are crucial in preventing such life-threatening outcomes.