The perforation of a peptic ulcer may be acute or chronic, the former perforating freely into the general peritoneal cavity, while the latter results in a localized peritonitis. The chronic perforation occurs more often; the local inflammatory reaction causes the perforated viscus to become adherent to some neighboring structure, as the pancreas, liver, gallbladder, intestine, omentum or parietal peritoneum. In a group of 152 consecutive cases of peptic ulcer admitted to the surgical service of Barnes Hospital, 104 ulcers were duodenal and forty-eight were gastric. Two patients had both duodenal and gastric ulcers. Among the cases there were four acute and three chronic perforating duodenal ulcers, in contrast to five acute and seven chronic perforating gastric ulcers, making a total of nineteen perforating peptic ulcers, or 12.5 per cent. of the total of 152 cases. Acute perforation of both types of ulcer occurred in 5.9 per cent, of the cases.
COPHER GH. DEMONSTRATION OF SPONTANEOUS PNEUMOPERITONEUM BY THE ROENTGEN RAY: AN AID IN THE DIAGNOSIS OF ACUTE PERFORATING PEPTIC ULCER. JAMA. 1924;82(10):781–783. doi:10.1001/jama.1924.02650360023007
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