Interesting Case of Contained Perforated Peptic Ulcer With Pancreatic Communication Causing Hemorrhagic Shock

Peptic ulcer disease (PUD) is a common gastrointestinal diagnosis affecting the stomach and proximal duodenum. A contained perforation with pancreatic communication is an exceedingly rare subtype where gastroduodenal perforation is limited by the surrounding pancreas, preventing free leakage of gastric and pancreatic contents into the peritoneal cavity. A 48-year-old male with a history of perforated antral ulcer requiring surgical management and placement of a Graham patch presented with upper gastrointestinal bleeding. Initial esophagogastroduodenoscopy (EGD) showed a new clean-based antral ulcer; however, the patient continued to experience hematemesis post-procedure. A repeat EGD revealed the same antral ulcer now with suture material exposed near the prior site of the Graham patch, along with a soft tissue mass resembling the pancreas and no evidence of active bleeding. Following this EGD, the patient had profuse hematemesis with hemorrhagic shock and underwent emergent exploratory laparotomy confirming contained posterior perforation of the stomach with complete erosion of the stomach wall onto the head of the pancreas. This case highlights an atypical presentation for a perforated peptic ulcer (PPU) with pancreatic communication.