Perforated Gastroduodenal Ulcers Research Articles

Perforated gastroduodenal ulcers: perioperative prognosis and prevention of complications

Objective. To improve the effectiveness of treatment for patients with perforated gastroduodenal ulcers (PGDU) by developing criteria for predicting postoperative complications and mortality. Materials and methods. The treatment outcomes of 127 patients with PGDU were analyzed. Prognostic scales ASA, SOFA, Peptic Ulcer Perforation Score (PULP), and the Mannheim Peritonitis Index (MPI) were used for the assessment in all the patients. Specialized classifications (DEP and ulcer defect classes) developed at Sklifosovsky Research Institute For Emergency Medicine were employed to determine the surgical approach and the extent of surgical intervention. Results. Duodenal ulcers were observed in 97(76.4 %) patients, gastric ulcers in 28(22.0 %), and combined ulcers in 2(1.6 %). According to the clinical form, chronic ulcers were identified in 81 (63.8 %) patients, while acute ones were detected in 46(36.2 %) patients. Helicobacter pylori infection was revealed in all patients with chronic ulcers. The majority of patients sought medical care within the first 6 hours after perforation (53 patients, 41.7 %); from 6 to 12 hours – 24 patients (18.9 %), 12–24 hours – 17 patients (13.4 %), and in more than 24 hours – 33 patients (26.0 %). Fatal outcome occurred in 45 (35.4 %) patients, while 82 (64.4 %) patients were discharged after the recovery had been observed. The mortality rate was significantly higher in patients with MPI grades 2 and 3, in those with an initially high risk according to the PULP scale, and those who were hospitalized more than 24 hours after perforation. Indications for laparoscopic ulcer suturing were proposed based on the scales used. Conclusions. The risk factors for adverse outcomes in PGDU include the following criteria: surgery performed more than 24 hours after perforation, MPI 2-3 grades, and a PULP scale score more than 8. In patients with PGDU who are at high surgical-anesthetic risk and have a complicated comorbid background, the risk of sepsis development is more than 30 %. Laparoscopic techniques for suturing PGDU are preferable when performed within 6 hours of perforation, with a PULP score not more than 7, MPI grade 1, and DEP classification scores less than 9, specifically in IIC, IIIC, IVA, IVB, and IVC ulcer defect classes.

IMMEDIATE RESULTS OF MINIMALLY INVASIVE SURGERY FOR COMPLICATED PEPTIC ULCERS OF THE STOMACH AND DUODENUM

Objective: To enhance the immediate treatment outcomes of complicated peptic ulcers of the stomach and duodenum through the development and application of video-assisted organ-preserving surgeries. Materials and Methods: This study analyzed the treatment outcomes of 261 patients with complicated gastric and duodenal ulcers. The patients received the treatment in the surgical departments of Azerbaijan State Advanced Training Institute for Doctors named after A. Aliyev, Scientific Surgical Center named after M.A. Topchubashev, and Sabunchi Medical Center from 2015 to 2023. All patients with perforated and bleeding ulcers of the stomach and duodenum underwent clinical and instrumental examinations. The initial general condition of the patient was thoroughly assessed. Among the patients, there were 220 men (84.3%) and 41 women (15.7%), with ages ranging from 18 to 84 years. There were 75 (28.7%) patients complicated with bleeding of gastric and duodenal ulcer, and 186 (71.3%) patients with perforation. In the control group, traditional, "open" surgical interventions were performed in 164 (62.8%) patients, and minimally invasive endoscopic video-assisted operations were performed in 97 (37.2%) cases. Out of 186 patients, 124 (66.7%) underwent traditional suturing of a perforated gastroduodenal ulcer during laparotomy, while 62 (33.3%) underwent minimally invasive endosurgical interventions. In the control group, 12 (8.4%) patients underwent gastric resection, and 10 (5.4%) underwent vagotomy with pyloroplasty. The immediate results of radical operations for a perforated ulcer were characterized by a high percentage of early complications, with 5 (41.6%) cases. Results. Of the 186 patients operated on for perforated gastroduodenal ulcer, 12 individuals (6.5±2.9%) developed complications in the postoperative period: 9 (7.3%) in the comparison group, and 3 (4.8%) patients in the main group. We obtained a statistically significant shorter duration of a surgical intervention by 24.8 minutes and shorter hospital staying time due to a decrease in the duration of the postoperative period by 5.3 days, a lower number of postoperative complications by 2.5%, and a lower postoperative mortality by 2.4%. The duration of laparoscopic suturing of a perforated ulcer averaged 38.6 minutes. The duration of hospital staying averaged 6.9±1.2 days. The use of minimally invasive interventions for ulcerative duodenal bleeding was accompanied by a significant reduction in the rehabilitation period compared with that after traditional, "open" operations that amounted to 18.3+3.6 and 35.5±5.9 days, respectively. Postoperative mortality was 1.3% (1 patient in the control group died). Conclusion. The outcome of treatment depends on the age of patients, the timing of the onset of the disease, the severity of concomitant pathology, the severity and extent of peritonitis and the duration of ulcerative anamnesis.

Factors Affecting Morbidity and Mortality Rates in the Management of Perforated Gastroduodenal Ulcer in Al-Yarmouk Teaching Hospital

Factors Affecting Morbidity and Mortality Rates in the Management of Perforated Gastroduodenal Ulcer in Al-Yarmouk Teaching Hospital

What is the Ideal Surgical Approach for Perforated Gastro-Duodenal Ulcer?

This is a single-center, non-randomized retrospective study that compares various clinical and evolutionary aspects of patients with perforated gastro-duodenal ulcers in order to determine the best surgical approach. The study included 35 patients who underwent surgical treatment for a perforated gastro-duodenal ulcer at Brașov County Emergency Clinical Hospital (SCJU BV) between January 2021 and January 2023. They were then divided into two groups based on whether the surgery was laparoscopic or traditional. A variety of clinical and paraclinical data were collected and compared. There were no variations in gender distribution, age, or site of the ulcer perforation across the groups. Patients who underwent a laparoscopic procedure had a smaller ulcer perforation, a faster resumption of intestinal transit, and a shorter hospital stay than those who underwent a standard procedure. At 3 days postoperatively, the Neutrophil-to-Lymphocyte Ratio (NLR) and the Systemic Inflammation Response Index (SIRI) were significantly lower in the laparoscopic group. Patients who underwent traditional surgery had a higher Boey score, needed more complex interventions, and had a higher rate of postoperative complications and mortality. In perforated gastro-duodenal ulcer cases, the laparoscopic approach is a viable option with numerous advantages, particularly in patients with a low Boey score. Meanwhile, the traditional approach may be reserved for cases with a high Boey score and complex surgical interventions.

Хірургічні аспекти лікування перфоративних гастродуоденальних виразок із поєднаними ускладненнями пенетрацією, стенозом та гострою кровотечею

The problem of surgical treatment of perforation of gastroduodenal ulcers (GDU) remains relevant and difficult, despite the introduction of new schemes of anti-ulcer and eradication therapy. Algorithms of surgical approaches and tactics of surgical treatment of patients with perforated GDU in combination with other complications in various combinations have not been developed. Purpose - to improve the results of surgical treatment of GDU with associated complications. Materials and methods. The results of surgical treatment of patients with complicated GDU for the period from 2000 to 2022 are presented. In total, 353 (100%) patients with perforated GDU in combination with other complications (a combination of two or more complications) were operated on. There were 52 (14.7%) patients with gastric ulcer perforation, and 301 (85.3%) patients with duodenal perforation. There were 267 (75.6%) patients with a combination of two complications; with a combination of three complications in 78 (22.1%) patients; four - 8 (2.3%) patients. The combination of perforation with gastrointestinal bleeding was observed in 138 (39.1%) patients. Results. The vast majority of patients (267 (75.6%)) had a combination of two complications. The number of patients with a combination of three complications was 78 (22.1%). The number of patients with a combination of all complications was insignificant - 8 (2.3%) people. The implementation of the developed algorithm made it possible to reduce the number of postoperative complications and mortality from 12% to 6.5%. The highest rate of complications and mortality was observed among patients with a combination of multiple (three and four) complications who underwent gastric resection - 3 (33.3%) patients, and the lowest mortality rate was observed among patients who underwent organ-preserving operations - 6 (2.8%) patients. Conclusions. In patients with perforated GDU in combination with bleeding, the use of endoscopic hemostasis made it possible to stabilize the patient and better prepare him for surgical intervention, and reduce the number of postoperative complications and mortality rates by almost 2 times. The use of resection techniques was extremely limited and had the highest rate of complications and mortality. Implementation of the developed algorithm made it possible to optimize surgical tactics when combining perforation with other complications of GDU. The research was carried out in accordance with the principles of the Declaration of Helsinki. The research protocol was approved by the Local Ethics Committee of the institution mentioned in the work. Informed consent of the patients was obtained for the research. No conflict of interests was declared by the authors.

Early Identification of Patients with Potential Failure of Nonoperative Management for Gastroduodenal Peptic Ulcer Perforation

Introduction: We aimed to identify objective factors associated with failure of nonoperative management (NOM) of gastroduodenal peptic ulcer perforation (GDUP) and establish a scoring model for early identification of patients in whom NOM of GDUP may fail. Methods: A total of 71 patients with GDUP were divided into NOM (cases of NOM success) and operation groups (cases requiring emergency operation or conversion from NOM to operation). Using logistic regression analysis, a scoring model was established based on the independent factors. The patients were stratified into low-risk and high-risk groups according to the scores. Results: Of the 71 patients, 18 and 53 were in the NOM and operation groups, respectively. Ascites in the pelvic cavity on computed tomography (CT) and sequential organ failure assessment (SOFA) score at admission were identified as independent factors for NOM failure. The scoring model was established based on the presence of ascites in the pelvic cavity on CT and SOFA score ≥2 at admission. The operation rates for GDUP were 28.6% and 86.0% in the low-risk (score, 0) and high-risk groups (scores, 2 and 4), respectively. Conclusion: Our scoring model may help determine NOM failure or success in patients with GDUP and make decisions regarding initial treatment.

Laparoscopic direct suture of a perforated gastroduodenal ulcer: how I do it.

Laparoscopic direct suture of a perforated gastroduodenal ulcer: how I do it.

Laparoscopic treatment for perforated gastroduodenal ulcer: direct repair surgical technique

Laparoscopic treatment for perforated gastroduodenal ulcer: direct repair surgical technique

Morphological features of complicated gastroduodenal ulcers

The objective of the study was to evaluate structural changes in the margin of gastroduodenal ulcers complicated by perforation, bleeding or penetration in terms of the features of ulcer healing.Methods and materials. Histological and IHC studies were performed on 25 patients of the main group with perforated gastroduodenal ulcers and 23 patients of the control group with chronic recurrent ulcers complicated by bleeding and penetration. Histological sections were stained with hematoxylin and eosin, and Van Gieson's picrofuchsin. Immunohistochemical reactions were performed with antibodies to Ki-67, CD68, CD138, and CD34.Results. On macroscopic evaluation, a clear even margin of the perforation was noted. Histological examination with the background of acute dyscirculatory changes clearly shows a zone of necrosis and a weakly expressed layer of granulation tissue, which in majority of the cases was practically absent. The margin of a perforated ulcer consists of a minimally presented, clearly delimited zone of tissue detritus and a practically unchanged muscle layer. Plasma cells dominated in the cell infiltrate, and the index of proliferative activity in the epithelium of the ulcer margins was about 45 %, distributed fairly evenly.Conclusions. Perforated ulcers can be considered as a special group of ulcers with the most pronounced changes of infiltration by plasmatic cells and eosinophils, edema and acute dyscirculatory changes, uniform and fairly high proliferative activity of the epithelium. Changes in the margins of the perforated ulcer allow for complete regeneration without excessive scarring with precise suturing of the perforation.

Rare Types of Perforation of the Gastrointestinal Tract — Diagnosis, Tactics, Treatment

RATIONALE Hollow organ perforation is an urgent problem in abdominal surgery. According to the literature, the incidence of perforation is from 0.37% to 2.3% of cases among various acute surgical pathologies of the abdominal organs. The greatest attention in the literature is paid to the problem of perforated gastroduodenal ulcers. At the same time, a much smaller number of publications, both Russia and foreign, are devoted to other, more rare types of perforations. This situation is most likely explained by the low prevalence of other types of perforations, which, in turn, does not make them a less urgent problem in emergency surgery, which requires a modern approach to the treatment of this group of patients.PURPOSE OF THE STUDY Analysis of domestic and foreign literature on the diagnosis and treatment of rare types of benign intestinal perforations.MATERIAL AND METHODS A literature review was performed for the period from 1994 to 2020 in Russian and in English, available on Pubmed, Medline, Springer, Scopus, E-library, on topics such as perforated diverticula of the small intestine, perforation of Meckel’s diverticulum, perforated ulcers of the small intestine, perforation of the intestine by a foreign body. RESUltS With all the variety of surgical techniques for various types of perforation of the gastrointestinal tract, currently in the literature there are no specific criteria for choosing a particular method of intervention with regard to the cause, level, and duration of perforation.CONCLUSION The lack of unified approaches in the diagnosis and treatment of patients with rare GIT perforations dictates the need for a more in-depth study of this issue in order to apply and optimize the technique of videolaparoscopic approach, develop a treatment and diagnostic algorithm for patients with suspected perforations of the gastrointestinal tract using the video laparoscopic method.

Profiles and Clinical Outcomes of Perforated Peptic Ulcer with Boey Score 3 Treated with External Drainage in Indonesia

The treatment of peptic ulcers has changed substantially, and the rate of elective surgery for gastroduodenal peptic ulcers has fallen significantly; as a result, the rate of emergency surgery for perforated peptic ulcers has slightly increased. The Boey score is one of the most widely used prognostic scoring systems for predicting death in peptic ulcer perforation patients. The Boey scoring system has a positive connection with mortality risk. Patients with Boey Score 3 are patients who meet the high-risk criteria and have high morbidity and mortality rates. Conservative therapy can be utilized as an alternative to surgery in some cases with perforated gastroduodenal ulcers. In this study, we presented a clinical case of perforated peptic ulcer patient with Boey score 3 treated with external drainage for the conservative treatment.

Emergency laparoscopy in the treatment of perforated gastroduodenal ulcers

To compare the results of endoscopic and open treatment of perforated gastroduodenal ulcers. There were 445 patients with perforated gastroduodenal ulcers between 2013 and 2021. Endoscopic suturing of perforation was performed in 172 patients (38.7%), 273 ones underwent open surgery. Among 172 patients scheduled for endoscopy, 160 (93.6%) ones underwent laparoscopic suturing of perforation. Morbidity rate was 5.0% (n=8), postoperative mortality rate - 1.3% (n=2). Comparison of the outcomes after laparoscopic suturing of ulcers in 160 patients and open surgery in 134 patients showed that laparoscopy was followed by 2.5 times lower incidence of complications and 3 times lower postoperative mortality. Diagnostic laparoscopy is advisable in patients with perforated ulcers and no contraindications. In most cases, surgery can be successfully and effectively completed without conversion to laparotomy. Endoscopic closure of ulcerative defect is preferable since this procedure has certain advantages over traditional intervention, contributes to significant reduction in morbidity, mortality and hospital-stay.

Peritonites by Perforation of Gastroduodenal Ulcer in the General Surgery Department of Kankan Regional Hospital (Guinea)

The aim of this study was to gather epidemiological and diagnostic data, and to evaluate the therapeutic and evolutionary modalities of peptic ulcer perforation. Material and method: From October 1, 2012 to September 31, 2013, we performed a prospective descriptive study on 30 patients admitted to the general surgery department of Kankan hospital for peritonitis due to peptic ulcer perforation. Result: During this study we treated 30 patients urgently for Peritonitis due to peptic ulcer perforation, ie 8.26% of all cases. The average age of our patients was 43.16 years with extremes of 15 and 74 years. We noted a male predominance with a sex ratio M / F equal to 14. The most affected socio-professional layer was the farmers / gold washers 20 cases, ie 66.66%. The signs in favor of peritonitis due to peptic ulcer perforation were dominated by abdominal pain, abdominal defense or contracture in 100% of cases. Simple suture was the most used surgical technique in 24 cases, ie 80%. The postoperative effects were simple in 10 patients, ie 33, 33% and complicated in 12 patients. We recorded 8 cases of death or 26.66%. The mean length of hospital stay was 12.83 days with extremes of 1 and 40 days. Conclusion: Our study shows that peritonitis due to peptic ulcer perforation is a serious condition that can be life-threatening. The improvement of this prognosis depends mainly on the early diagnosis of the condition, effective means of resuscitation and the speed of the surgical procedures.

Efficacy and Safety Analysis of Laparoscopy for Acute Perforation of Gastroduodenal Ulcer

Efficacy and Safety Analysis of Laparoscopy for Acute Perforation of Gastroduodenal Ulcer

S2653 Candida Liver Abscesses Due to a Penetrating Duodenal Ulcer

Introduction: Fungal infections of the liver commonly occur in patients with neutropenia, hematologic malignancies, and chemotherapy. The most common isolated agents are species of the Candida family, originating from the translocation of the gastrointestinal tract to the liver. Here, we present a rare case of multiple fungal abscesses in an immunocompetent host due to a perforating duodenal ulcer. Case Description/Methods: A 59-year-old man with COPD, hypertension, peptic ulcer disease, and obesity presented for altered mental status and fever. He was found to have right lower lobe pneumonia and complete heart block treated with antibiotics, temporary transvenous pacing then leadless permanent pacemaker. During his stay, he presented with melena. He underwent an upper endoscopy that showed a large 40 mm nonbleeding cratered duodenal ulcer with possible perforation and a superficial gastric ulcer with a flat pigmented spot. A CT scan of the abdomen and pelvis showed 3 perihepatic fluid collections along the left lobe, right lobe, and gallbladder fossa with the largest measuring 9cmx1.5cmx9cm and associated pneumobilia. There was no intra-abdominal free air. The patient was clinically stable, afebrile, and denied significant abdominal pain. There were no signs of peritoneal irritation on the physical exam. He did have a persistent neutrophilic leukocytosis with a white cell count of 18,400/ml, Hemoglobin 9g/dl, total bilirubin 0.6 mg/dl, AST 29 IU/l, ALT 38 IU/l, Alkaline phosphatase 53IU/L. The patient was managed conservatively with broad-spectrum antibiotics and proton pump inhibitors. He underwent urgent percutaneous drainage of the 2 largest abscesses. Cultures from the collections grew Candida albicans only. Blood cultures were negative. Thus, the patient was treated with micafungin then transitioned to fluconazole for a 6-week course of therapy. Amoebic and Echinococcus antibodies, and HIV tests were negative. A follow-up CT showed resolution of the liver collections. Discussion: This is a rare case of candida liver abscesses as a complication of a penetrating large duodenal ulcer successfully treated with conservative management. Pyogenic liver abscesses are unusual presentations of perforated gastroduodenal ulcers. In addition to the drainage of the collections, antifungal agents should be considered in the initial antimicrobial regimen choice even in immunocompetent hosts.Figure 1.: From A to C: CT demonstrated liver abscesses (frontal and axial views); D: Upper endoscopy showing a cratered duodenal ulcer.

New machine learning scoring system for predicting postoperative mortality in gastroduodenal ulcer perforation: A study using a Japanese nationwide inpatient database

BackgroundConventional prediction models for estimating risk of postoperative mortality in gastroduodenal ulcer perforation have suboptimal prediction ability. We aimed to develop and validate new machine learning models and an integer-based score for predicting the postoperative mortality. MethodsWe retrospectively identified patients with gastroduodenal ulcer perforation who underwent surgical repair, using a nationwide Japanese inpatient database. In a derivation cohort from July 2010 to March 2016, we developed 2 machine learning-based models, Lasso and XGBoost, using 45 candidate predictors, and also developed an integer-based score for clinical use by including important variables in Lasso. In a validation cohort from April 2016 to March 2017, we measured the prediction performances of the models by computing area under the curve and comparing it to the conventional American Society of Anesthesiology risk score. ResultsOf 25,886 patients, 1,176 (4.5%) died after surgical repair. For the validation cohort, Lasso and XGBoost had significantly higher prediction abilities than the American Society of Anesthesiology score (Lasso area under the curve = 0.84; 95% confidence interval 0.81–0.86; American Society of Anesthesiology score area under the curve = 0.70; 95% confidence interval 0.65–0.74, P < .001). The integer-based risk score, which had 13 factors, had a prediction ability similar to those of Lasso and XGBoost (area under the curve = 0.83; 95% confidence interval 0.81–0.86). According to the integer-based score, the mortalities were 0.1%, 2.3%, 9.3%, and 29.0% for the low (score, 0), moderate (1–2), high (3–4), and very high (≥5) score groups, respectively. ConclusionMachine learning models and the integer-based risk score performed well in predicting risk of postoperative mortality in gastroduodenal ulcer perforation. These models will help in decision making.

Laparoscopy or laparotomy: a snapshot of the Australian approach to surgical repair of perforated gastroduodenal ulcers.

Laparoscopy or laparotomy: a snapshot of the Australian approach to surgical repair of perforated gastroduodenal ulcers.

Outcomes of Nonoperative Treatment for Gastroduodenal Ulcer Perforation: a Nationwide Study of 14,918 Inpatients in Japan

BackgroundGastroduodenal ulcer perforation is a common abdominal emergency that may be curable without surgical repair in non-elderly patients with localized and stable symptoms. However, the outcomes of nonoperative approaches have rarely been described. MethodsUsing a Japanese national inpatient database, we identified 14,918 patients with gastroduodenal ulcer perforation who were hospitalized and received nonoperative treatment from July 2010 to March 2017. We categorized these patients into three groups according to age: 18 to 64 years (young group, n=8407), 65 to 74 years (old group, n=2616), and ≥75 years (old-old group, n=3895). We investigated the characteristics, treatments, and outcomes in each group. ResultsMost of the patients were men (71%), and the median patient age was 62 years (interquartile range, 47–75 years). The old and old-old groups had more comorbidities than the young group. Whereas most patients were administered proton pump inhibitors and various antibiotics (96% and 90%, respectively), only 58% of patients underwent gastric tube placement. Surgical repair >3 days after admission was performed in 7.1% of all patients (6.3% vs. 7.9% vs. 5.5%, P<0.001). The old and old-old groups showed higher mortality (1.4% vs. 8.3% vs. 18%, P<0.001) and morbidity (6.6% vs. 15% vs. 17%, P<0.001) than the young group. The median length of stay was almost 2 weeks (13 vs. 17 vs. 20 days, P<0.001). DiscussionUnlike previous studies, many patients aged >65 years received nonoperative treatment in this nationwide cohort. Our findings provide useful information for clinicians and patients hospitalized for gastric ulcer perforation.

The effectiveness of laparoscopic technique in combination with laser irradiation in acute perforated gastroduodenal ulcers

Purpose . To study effects of intravenous laser blood irradiation (ILBI) with laser debridement of wounds and abdominal cavity, which are added to the standard laparoscopic and surgical treatment of perforated gastroduodenal ulcers. Material and methods . 31 patient with perforated gastroduodenal ulcers and symptoms of peritonitis were treated in the hospital. They were divided into two groups. In the control group (n = 19), after preoperative preparation patients were operated laparoscopically with suturing a perforated ulcer, sanitation and drainage of the abdominal cavity. In the main group (n = 12), after preoperative preparation, laparoscopic suturing of a perforated gastroduodenal ulcer in combination with ILBI, laser debridement of the wound and abdominal cavity were made. On admission, all patients were examined by the standard scheme: clinical examination, instrumental examinations (R-scan of chest, ultrasound examination of abdominal organs, electrocardiography, external respiration). To solve the task, the generally accepted clinical examination steps were added with biochemical testings (dynamics of changes in free radical lipid oxidation processes and in antioxidant blood protection parameters). Results . When treating patients with perforated gastroduodenal ulcers laparoscopically in combination with ILBI and laser debridement of wounds and the abdominal cavity, the researchers noted the following in the main group: better indices of average mass molecules (MSM), less blood intoxication, immunity increase – what, in its turn, leads to the increase in lipid peroxidation and antioxidant protection at the final stage of treatment. Such positive effects have decreased the number of postoperative complications as well as the average duration of treatment, if to compare with traditional care, thus ultimately, leading to less financial costs. Conclusion . The laparoscopic technique in combination with ILBI and laser wound and abdominal sanitation in patients with perforated gastroduodenal ulcers is a promising modality which has a high medical and social importance.

Diagnosis of perforation from the penetrating ulcer of the posterior wall of the duodenum

The article is devoted to the problem of emergency surgery for abdominal organs – perforated ulcer of the posterior duodenal wall (duodenum). 140 patients with perforated duodenal ulcer were treated at the N.V. Sklifosovsky Research Institute for Emergency Medicine between 2016 and 2019. Eight patients had perforation from the penetrating ulcer of the posterior duodenal wall. The average age of patients with perforation from the penetrating ulcers in the posterior duodenal wall was 62.25 years (27 to 78 years). Most of the cases were found in men – 87.5%. 7 patients had surgery at the Institute, one was transferred from another medical institution where he underwent surgery. Four patients were discharged with a favorable outcome, and four died. Two of the deceased patients had perforation associated with penetrating duodenal ulcer that was diagnosed during laparotomy; in two other cases, perforation associated with the penetrating ulcer was detected only during autopsy. A feature of perforated gastroduodenal ulcers when they are localized on the posterior wall of the duodenum is poor clinical manifestation, which is associated with the entry of duodenal contents into a limited retroperitoneal space, leading to a significant inflammatory process of retroperitoneal tissue. Complex use of X-ray examination, oesophagogastroduodenoscopy, and CT allows to correctly assess and timely diagnose perforation associated with the penetrating ulcer of the posterior wall of the duodenum into the retroperitoneal space.