Although populations caught in certain stress situations may experience a sudden increase in the frequency of ulcer perforation, the worldwide incidence of perforation is probably not changing. The proportion in women appears to be increasing rapidly, however, and the frequency of perforation is probably increasing among older people. About one quarter of patients with ulcer perforation have not previously had ulcer symptoms. There is simultaneous ulcer hemorrhage in about 7% of cases. The overall mortality of recent years has been about 11%, higher for gastric than duodenal ulcer. The main pathologic determinant of clinical seriousness is whether or not the contamination is for the moment restricted to the relatively small lesser peritoneal sac. The main reason for today's continued high mortality is continued delay in getting the patient to the surgeon.
Palmer ED. Perforation of Gastroduodenal Ulcer. Arch Intern Med. 1972;130(6):957–964. doi:10.1001/archinte.1972.03650060141026
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