Simultaneous perforation of benign gastric and duodenal ulcers.

Finney (I900) stated that in 20 per cent. of patients with a perforated peptic ulcer, more than one perforation occurred. Fifty years later Aird gives a figure of less than I per cent.; both report multiple perforations of a single large ulcer. Yet, while every volume of the 'Index Medicus' contains hundreds of references to peptic ulceration, reports of double perforations are rare. Masson and Simon (1927) collected thirty-three case reports; the diagnosis was made usually at autopsy--rarely at operation, and never clinically, The mortality was high. Only eighteen patients came to operation and the only four who recovered were those in whom both perforations were closed. Austin (I938) reported a man of twenty-seven, with simultaneous perforations of low gastric and high duodenal ulcers, who survived closure of both. Livingstone (195o) also reported the successful closure of simultaneous gastro-jejunal and jejunal perforations. Concomitant gastric and duodenal ulcers have been studied in recent papers by Johnson (I955) and Feldman (I953); both of whom emphasized that their co-existence is by no means uncommon. Feldman collected figures from twenty-five authors; the average percentage for double ulceration being about ten. He believed that the duodenal ulcer occurred first and the gastric ulcer later. Johnson holds similar views and stresses that many have gross pyloric stenosis. He found double ulceration in 9 per cent. of his surgical series of 313 patients.