Perforated peptic ulcer is characterised by severe, constant, sudden onset epigastric pain that often requires high doses of opiate analgesia before the patient settles. There may be haematemsis.
Peptic ulcer perforation results in a chemical peritonitis rather than a bacterial peritonitis in the initial stages - unlike perforations of the more distal bowel. Thus, in the first 24 hours or so, the patient does not show signs of general toxicity. After this period secondary bacterial infection occurs and signs of sepsis are present.
Note that if a posterior gastric ulcer perforates then the gastric contents leak into the lesser sac. This condition presents more insidiously than other peptic ulcer perforations.
Last reviewed 01/2018