Current Practice DISEASE OF THE DIGESTIVE SYSTEM Perforated Peptic Ulcer

Perforations of peptic ulcers account for between 5 % and 8% of abdominal conditions submitted to urgent laparotomy. The general practitioner may see less than one case a year even though in an average-sized practice he has many patients with peptic ulcers. This relative rarity of the complication of perforation in the experience of the individual practitioner does not often lead to difficulty in diagnosis. For few other conditions is he more thoroughly indoctrinated as a student, textbook descriptions are vivid, and when one typical case has been seen the picture is not readily forgotten. This particular "classical" description-unlike many other classical descriptions of disease-is only rarely misleading. Generalizations may be made that in females duodenal perforations are about twice as common as gastric perforations while in males the ratio is nearer eight to one. In the experience of the general practitioner perforation is a much less frequent acute complication of ulcer than haemorrhage. In a profile of the peptic ulcer problem as seen by the general practitioner Fry' records in a ten-year period 16 perforations, of which 14 were duodenal in the male, 1 duodenal in the female, and 1 gastric in the male. In all the peptic ulcer cases in his practice 14% developed the complication of bleeding and 6% perforated.