PERFORATED PEPTIC ULCER WITH INTERMITTENT LEAKAGE

It is universally believed that, following the initial violent pain, the clinical picture and course of a perforated peptic ulcer are relatively uniform. The current teaching with regard to the symptomatology of ruptured ulcer subsequent to perforation may be summarized as follows: In the average case the intense pain of onset continues unabated unless relieved by large doses of morphine or by surgical intervention. If operation is not performed, the clinical picture of a diffuse suppurative peritonitis supervenes, preceded at times by a temporary subsidence of pain, the so-called period of quiescence or repose. In all but a small proportion of cases, generally stated to be less than 5 per cent, the infection progresses rapidly and leads to death within a few days. The small group of patients who recover from the diffuse, purulent peritonitis pass through a stormy convalescence during which surgical drainage of one or more intra-abdominal abscesses