Perforation in patients with bleeding ulcer.

Twelve patients developed perforation after haemorrhage in a consecutive series of 840 cases admitted for bleeding chronic peptic ulcer. Death occurred in 3 of the 9 cases with duodenal ulcer and 1 of the 3 cases with gastric ulcer. There were 5 giant and 4 kissing duodenal ulcers and all 3 cases with gastric ulcer had a giant ulcer. The 12 patients were similar to the rest of the series in terms of ulcer site and shock on admission but were older and in poorer medical condition, more had ingested analgesics, more had giant ulcers and the mortality was greater (33% vs 6%). Giant ulceration was the only risk factor of potential clinical value as a predictor of the danger of ulcer perforation. One death occurred in 8 cases treated by early definitive surgery, suggesting this to be the treatment of choice for this unusual complication of peptic ulcer.