[Perforated peptic ulcer in patients with central nervous system injury]

There were 10 cases of perforated peptic ulcer (PPU) occurring in patients with central nervous system injury from July 1982 to December 1991; 7 cases occurred in intensive care unit whereas 3 cases occurred in the ordinary ward. Because of inability of these patients to express abdominal pain, the diagnosis of PPU was suspected only in the presence of the frequently associated clinical signs such as abdominal distension, fever, tachypnea, tachycardia, and hypotension. Because the diagnosis of PPU in these patients is generally delayed, mortality up to 60% is noted. The diagnosis of PPU was made by chest X-ray with pneumoperitoneum in only 5 of the 10 patients, whereas that of the remaining 5 patients was made by peritoneal lavage with bile-like ascites. There is a good correlation between the presence of shock after PPU and the survival of the patients. We recommend that once there are abnormal abdominal signs, inexplicable hemodynamic changes in patients with central nervous system injury, immediate thorough examination in search of PPU should be made to detect early the life-threatening PPU and to reduce the mortality thereafter.