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Signs and Symptoms of a Perforated Peptic Ulcer

author image Dr. C. Richard Patterson
C. Richard Patterson is a retired surgeon and chief medical officer with special interest and experience in gastrointestinal, breast, cancer and trauma surgery. He is the author or co-author of 17 scientific publications, including textbook chapters.
Signs and Symptoms of a Perforated Peptic Ulcer
Woman with doctor clutching her stomach Photo Credit JackF/iStock/Getty Images

Peptic ulcers are erosions of the tissues lining the upper digestive tract, particularly the stomach and first portion of the small intestine. They are often caused by a bacterial infection that compromises your defense against the acid produced in the stomach. The erosions may penetrate completely through the stomach or intestinal wall, resulting in perforation and the spillage of acid and other contents into the abdominal cavity.

Symptoms of Perforated Peptic Ulcer

The first symptom of a perforated peptic ulcer is usually intense and severe pain. The experience is so drastic, you'll remember exactly when it happened, where you were, what you were doing, and even the exact words being spoken by a companion or on television. The pain is at its maximum immediately and persists, being worsened by movement, jostling, touching, coughing or sneezing. You may also experience fainting, excessive sweating and a rapid heartbeat.

Symptoms That May Precede Perforation

Although perforation may be the first symptom of peptic ulcer disease, it is often preceded for days or weeks by milder symptoms. Pain between the breastbone and the navel may occur when the stomach is empty and may be relieved with antacids. The pain may come and go and may be worse at night. Dark, tarry bowel movements or the passage of what appear to be coffee grounds may signal bleeding from a peptic ulcer.

Signs of Perforated Peptic Ulcer

Someone with a perforated ulcer lies quietly and breathes shallowly. He may be pale and clammy, and the heart rate is likely to be rapid. The abdomen is rigid to the touch and tender. Light tapping on the abdomen will often produce a hollow, drumlike sound. The diagnosis can be confirmed with a simple x-ray showing abnormal gas collections inside the abdomen.

Wrong Diagnosis

Although the classic symptoms and signs are usually present and lead your doctor to make a correct diagnosis, perforated peptic ulcer may be confused with other inflammatory diseases of the abdomen. In 1926, actor Rudolph Valentino was mistakenly diagnosed with and operated upon for appendicitis rather than his perforated ulcer. He died of peritonitis, giving his name to "Valentino Syndrome."

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