Perforated peptic ulcer occurs in men more the women and has its highest incidence in the 40 to 60 year age groups.
If a peptic ulcer erodes the wall of the stomach or duodenum at a point where it is covered by visceral peritoneum, the lumen of the gut becomes connected to the peritoneal cavity. Subsequent escape of gastric acid or alkaline bile into the peritoneal cavity causes a chemical and later a bacterial peritonitis which is acutely painful.
The majority of patients give a history of indigestion or epigastric pain typical of a duodenal or gastric ulcer.
It is important to enquire whether the patient has taken any steroids or aspirin because both of these drugs can cause ulcers and exacerbate old ulcers to the point of perforation.