Duodenal ulcer double jeopardy: a case report of sequential bleeding and perforation

Azra Tabassum; Summiaya Ali; Selwyn Selvendran

doi:10.18203/2349-2902.isj20253844

Authors

Azra Tabassum We reported a rare case of a 78-year-old woman who presented with acute duodenal ulcer bleeding requiring emergency surgical intervention. Despite initial control of the bleeding, she subsequently developed a new duodenal ulcer perforation, which necessitated prompt reoperation. This case highlights the importance of timely surgical intervention and meticulous clinical decision-making in managing complex gastrointestinal emergencies in an acute surgical setting.
Summiaya Ali Department of General Surgery, Campbelltown Hospital, New South Wales, Australia
Selwyn Selvendran Department of General Surgery, Campbelltown Hospital, New South Wales, Australia

DOI:

https://doi.org/10.18203/2349-2902.isj20253844

Keywords:

Bleeding duodenal ulcer, Duodenal ulcer perforation, Emergency surgical intervention

Abstract

We reported a rare case of a 78-year-old woman who presented with acute duodenal ulcer bleeding requiring emergency surgical intervention. Despite initial control of the bleeding, she subsequently developed a new duodenal ulcer perforation, which necessitated prompt reoperation. This case highlights the importance of timely surgical intervention and meticulous clinical decision-making in managing complex gastrointestinal emergencies in an acute surgical setting.

Metrics

Metrics Loading ...

References

Wang S, Zhang T, Li D, Cao X. The global, regional and national burden of peptic ulcer disease attributable to smoking from 1990 to 2021: A population-based study. Prev Med Rep. 2025:51:103019. DOI: https://doi.org/10.1016/j.pmedr.2025.103019

Unver M, Fırat O, Ünalp OV, Uğuz A, Gümüş T, Sezer TO, et al. Prognostic factors in peptic ulcer perforations: a retrospective 14-year study. Int Surg. 2015;100(5):942-8. DOI: https://doi.org/10.9738/INTSURG-D-14-00187.1

Winters WL, Egan S. The incidence of hemorrhage occurring with perforation in peptic ulcer. JAMA. 1939;113;(25):2199-204. DOI: https://doi.org/10.1001/jama.1939.02800500005002

Blackford JM, Williams RH. Fatal hemorrhage from peptic ulcer one hundred and sixteen cases collected from vital statistics of Seattle during the years 1935-1939. JAMA. 1940;115(21):1774–9. DOI: https://doi.org/10.1001/jama.1940.02810470018005

Shu CP, Nwegbu CG, Ginette DYA, Allen J. Brown kissing duodenal ulcer in a young adult presenting as upper gastrointestinal bleeding in a resource-limited setting: A case report and literature review. Int J Surg Case Rep. 2025;127:110942. DOI: https://doi.org/10.1016/j.ijscr.2025.110942

Ahn JY, Jung HY. Duodenal kissing ulcers with simultaneous sealed perforation and posterior hemorrhage. Clin Endosc. 2013;46(3):306-9.

Al-Hadithi R. Giant duodenal ulcer with bleeding and contained perforation: case report and review. Int J Surg Case Rep. 2014;5(12):1223-6.

Lau JY, Barkun A, Fan DM, Kuipers EJ, Yang YS, Chan FK. Challenges in the management of acute peptic ulcer bleeding. Lancet. 2013;381(9882):2033-43 DOI: https://doi.org/10.1016/S0140-6736(13)60596-6

Hassan Azhari. The global incidence of peptic ulcer disease is decreasing since the turn of the 21st century: a study of the organisation for economic co-operation and development (OECD). Am J Gastroenterol. 2022;117(9):1419-27. DOI: https://doi.org/10.14309/ajg.0000000000001843

Wang YR, Richter JE, Dempsey DT. Trends and outcomes of hospitalizations for peptic ulcer disease in the United States. J Clin Gastroenterol. 2010;44(6):416-22.

Jairath V, Barkun AN. Improving outcomes in acute upper gastrointestinal bleeding. Gut, 2018;67(8):1324-32.

Chen CH, Kuo CM. Sequential bleeding and perforation of duodenal ulcer: a case report. World J Gastroenterol. 2015;21(15):4731-4.

Tanaka K, Takahashi T. Pyloric exclusion and gastrojejunostomy for perforated peptic ulcers. J Gastrointest Surg. 2018;22(5):841-8.

Kumar A, Kumar S. Surgical management of peptic ulcer disease: a review. J Clin Diagn Res. 2019;13(9):1-4.

Møller MH, Adamsen S. Perforated peptic ulcer: how to improve outcome? Scand J Gastroenterol. 2017;52(6-7):677-85.

Lau WY, Leung KL. Surgical management of perforated peptic ulcer: a 10-year experience. Aust N Z J Surg. 1995;65(5):332-6.

Brooks FP. The pathophysiology of peptic ulcer disease. Dig Dis Sci. 1985;30(11):15-29. DOI: https://doi.org/10.1007/BF01309381

Jianping L. Analysis of risk factors for duodenal leak after repair of a duodenal perforation BMC Surg. 1984;13(2):635-50.

Chong L, Xiwen C, Hongxia W. Pathogenesis of pepsin-induced gastroesophageal reflux disease with advanced diagnostic tools and therapeutic implications. Front Med (Lausanne). 2025:12:1516335. DOI: https://doi.org/10.3389/fmed.2025.1516335

Ranjan A, Nahr S. Are NSAIDS really responsible for increasing incidence of duodenal perforation-our experience. Ann Int Med Dent Res.2017;4(1):51-4. DOI: https://doi.org/10.21276/aimdr.2018.4.1.SG13

Roberts‐Thomson IC. How did the ancient bacterium, Helicobacter pylori, cause an epidemic of chronic duodenal ulceration. JGH Open. 2021;5(6):636-42. DOI: https://doi.org/10.1002/jgh3.12560

Franzin G, Musola R, Mencarelli R. Changes in the mucosa of the stomach and duodenum during immunosuppressive therapy after renal transplantation. Histopathol. 1982;6(4):439-49. DOI: https://doi.org/10.1111/j.1365-2559.1982.tb02741.x