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Understanding Perforated Ulcers

A peptic ulcer is an open sore in the stomach lining or the upper part of the small intestine (duodenum). An ulcer can go through all the layers of the digestive tract and form a hole. This is called a perforated ulcer. A perforated ulcer lets food and digestive juices leak out of the digestive tract. This is a serious health problem that needs urgent medical care.

Cross section of stomach showing perforated ulcer.

What causes perforated ulcers?

A hole can form if peptic ulcers are not treated. To find the cause of your ulcer, your doctor will give you an exam and review your health history. They may also order tests. The main causes of peptic ulcers include:

  • Infection with the H. pylori ( Helicobacter pylori) bacteria. This damages the stomach lining. Digestive juices can then harm the digestive tract.

  • Long-term use of some over-the-counter pain medicines such as NSAIDs (non-steroidal anti-inflammatory drugs). These include ibuprofen, naproxen, and aspirin. This makes stomach or intestinal damage more likely.

Symptoms of a perforated ulcer

Symptoms of a perforated ulcer may include:

  • Sudden, severe pain in the belly, usually in the upper area.

  • Pain spreading to the back or shoulder.

  • Nausea or vomiting.

  • Lack of appetite or feeling full.

  • Swollen belly or feeling bloated.

  • Feeling lightheaded.

  • Increased heart rate.

Treatment for a perforated ulcer

Treatment for a perforated ulcer starts with fixing the hole in your digestive tract. This repair requires surgery. It may be an open surgery, with one large cut in the belly. Or it may be a laparoscopic repair, with several small cuts.

Other treatments are used to ease pain and remove the cause of the ulcer. Prescription medicines may help to:

  • Reduce the amount of acid the stomach makes.

  • Coat the lining of the stomach and the duodenum.

  • Treat infections.

Possible complications of a perforated ulcer

Perforated ulcers can have serious complications. These include:

  • Infection and inflammation of the lining of the abdomen (peritonitis).

  • Bloodstream infection (sepsis).

  • Death.

When to contact your doctor

Contact your doctor right away if you have:

  • Blood in your vomit, or vomit that looks like coffee grounds.

  • Bloody, black, or tarry-looking stools.

  • Fever of 100.4°F (38°C) or higher, or as directed by your doctor.

  • Chills.

  • Pain that gets worse.

  • Symptoms that don’t get better with treatment, or symptoms that get worse.

  • New symptoms.

Online Medical Reviewer: Daphne Pierce-Smith RN MSN
Online Medical Reviewer: Lalitha Kadali
Online Medical Reviewer: Melinda Murray Ratini DO
Date Last Reviewed: 5/1/2022
© 2000-2025 The StayWell Company, LLC. All rights reserved. This information is not intended as a substitute for professional medical care. Always follow your healthcare professional's instructions.
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