Penetration beyond the alimentary wall, characterized by dense fibrous adhesion or confined perforation, was found at operation in 139 of 350 peptic ulcers. The pancreas was the commonest site of penetration. This complication of peptic ulcer disease, often associated with medical intractability, is best recognized not in the laboratory but rather in the changing pattern of symptoms described by the patient.
Norris JR, Haubrich WS. The Incidence and Clinical Features of Penetration in Peptic Ulceration. JAMA. 1961;178(4):386–389. doi:10.1001/jama.1961.03040430022005
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