Sudden attack of pain in epigastrium to the right of midline in case of perforation of duodenal ulcer. In case of gastric ulcer the pain is in epigastrium. There is history of burning pain in epigastrium, flatulence and dyspepsia. History of drug intake without sufficient food intake may be present. In case of intestinal perforation pain starts from the site of perforation, visceral, and then spreads all over the abdomen. In any case there is board-like rigidity of abdomen, tenderness, and rebound tenderness. After some time the abdomen becomes silent, heart sounds can be heard all over. Patient stops passing flatus and motion, abdomen is distended. Gastrointestinal perforation results in severe abdominal pain intensified by movement, nausea, vomiting and hematemesis. Later symptoms include fever and or chills.
On x-rays, free gas/air may be visible in the abdominal cavity. Free air is easily visualized on x-ray while the patient is in the upright position. The perforation can often be visualised using computed tomography. White blood cells are often elevated. Visible signs can occasionally include a rigid abdomen on palpation.
Treatment depends on the underlying cause. Surgical intervention is nearly always required in form of exploratory laparotomy and closure of perforation with peritoneal wash. Conservative treatment including intravenous fluids, antibiotics, nasogastric aspiration and bowel rest is indicated if the patient is nontoxic and clinically stable. Consultation with a specialist is often needed.