A perforated duodenal ulcer can lead to severe complications, as it allows bacteria from the intestine to escape into and infect the lining of the abdomen. The infection can lead to sepsis, which can be fatal.
It is rare for duodenal ulcers to perforate, but the condition can be life threatening.
This article examines duodenal perforation and the associated symptoms, causes, and risk factors. It also looks at diagnosis, treatment, possible complications, and the outlook for people with the condition.
Duodenal ulcers are a type of peptic ulcer that occurs in the upper area of the small intestine, known as the duodenum. The ulcers are part of PUD, which affects part of the duodenum and the stomach.
Certain substances may cause injury to the gastroduodenal mucosa, a protective barrier that prevents gastric juices from digesting a person’s organs. This may lead to perforation, which involves the lining of the duodenum splitting open.
In contained perforation, the ulcer creates a hole, but organs such as the pancreas block the area and prevent the bowel contents from leaking freely into the abdomen.
Symptoms of duodenal perforation
Long-term use of NSAIDs can irritate and damage the lining of the digestive system and increase a person’s risk of developing peptic ulcers.
This type of bacteria infects the small bowel and stomach and is one of the
It can irritate the lining of the digestive tract, which can lead to the development of peptic ulcers and increase the risk of perforation. The prevalence of the bacteria in people with duodenal ulcers ranges from 50–80%.
- autoimmune conditions, such as Crohn’s disease and scleroderma
- duodenal diverticula, which are small bulges that may occur in the intestine
- infectious diseases, such as norovirus and rotavirus
- impacted gallstones in the duodenum
- duodenal ischemia, in which blood and oxygen do not flow to the duodenum effectively
- injury from procedures or surgery, such as endoscopy and laparoscopic cholecystectomy
A doctor may order various tests to diagnose duodenal perforation and rule out other diagnoses.
Chest X-rays and CT scans can help doctors identify free air, or gas, under the diaphragm, which
The condition can be fatal if a person does not receive treatment for a duodenal perforation. Initial treatment may
- intravenous antibiotics
- proton pump inhibitory (PPI) medications
- urinary catheter
- nasogastric tube
Doctors will evaluate a person to determine how to best treat their condition. Nonsurgical treatment options
After initial treatment, doctors may closely monitor a person’s condition and administer intravenous antibiotics and nasogastric suction. Nasogastric suction involves the removal of gasses, liquids, and solids from the stomach and intestine via a small tube that doctors insert through the nose.
A doctor may need to treat a duodenal perforation with surgery. The
Graham patch surgery involves a doctor plugging the perforation with a free omental plug. A surgeon forms an omental plug from the omentum, a layer of tissue on the surface of the intraperitoneal organs.
Cellan-Jones repair surgery involves surgeons closing the perforation with sutures and then covering the repair with a flap that the omentum forms.
Complications may arise from the duodenal perforation or from surgery to treat the condition.
A common complication of the perforation is sepsis. Between 30% and 35% of people who enter the operating theatre with a perforated peptic ulcer have sepsis, accounting for
Around 30% of patients with perforated peptic ulcers experience postoperative complications. These can include:
Various factors can influence the outlook for a person with duodenal perforation. The outlook is typically poorer if the time between the perforation and treatment is greater than
Other factors that may result in a poor outcome include whether the person:
- is older than 60 years of age
- has comorbidities
- has acute kidney failure
- is in shock at the time of their admission
- is a smoker
- is underweight
- is female
- has metabolic acidosis
- has low blood pressure
More than a quarter of people who undergo surgery for perforation develop septic shock within a month. There is a mortality rate of 50–60% within this group.
Any person who experiences sudden abdominal pain that worsens steadily should contact a doctor as soon as possible or contact emergency medical services if the pain occurs outside of regular doctor’s hours.
Duodenal ulcers are a type of peptic ulcer in the duodenum, an area of the small intestine. Factors such as chronic use of NSAIDs or the bacteria H. pylori may irritate the protective lining of the intestine and cause the ulcer to perforate, or split open.
A perforation can lead to severe and fatal complications, as the contents of the bowel can leak into the abdominal cavity. This can lead to peritonitis and sepsis.
It is important that anyone with symptoms such as sudden and severe abdominal pain contacts a doctor as soon as possible. A period longer than 24 hours between perforation and treatment can result in a poorer outcome.
Treatment can involve medication, monitoring, or surgery to repair the perforation. The mortality rate for people with duodenal perforation is 8–25%.