Instrumental perforation of the oesophagus and perforated duodenal ulcer.

Instrumental perforation of the oesophagus is a serious and, unfortunately, not a very rare accident. The occurrence in addition of perforation of a duodenal ulcer constitutes a situation which is rare, difficult to diagnose, and fraught with great danger to the patient. Simultaneous perforation of multiple peptic ulcers has been described in several reports since that of Finney (1900). As peptic ulceration of the stomach and duodenum may be associated with peptic ulceration of the oesophagus, the synchronous perforation of these organs is a possibility. Apart from the type of case described by Yudin (1944) in which ingested corrosive causes destruction of the oesophagus and stomach, I can find no record of coexistent duodenal and oesophageal perforation. In the following case coexistence of perforations of the oesophagus and duodenum is described.