Nonoperative Management of a Perforated Peptic Ulcer in the Setting of Decompensated Alcoholic Cirrhosis

A Case Report

Authors

  • Sam Dunseith University of Toledo
  • Dr. Sarah Hill Department of Surgery, The University of Toledo, Toledo, OH
  • Dr. Kunal Yadav Department of Surgery, The University of Toledo, Toledo, OH

DOI:

https://doi.org/10.46570/utjms-2026-1698

Keywords:

Peptic ulcer disease, Bleeding peptic ulcer, Decompensated cirrhosis, Alcoholic cirrhosis, Nonoperative management

Abstract

Perforation of peptic ulcers is typically considered a surgical emergency, but management must account for patient comorbidities. Surgical management of perforated ulcers in the setting of decompensated cirrhosis can be complicated by coagulopathy and delayed wound healing, leading to increased morbidity and mortality. This case outlines the nonoperative management of a perforated peptic ulcer in a 47-year-old male with decompensated alcoholic cirrhosis. Computed tomography scan revealed pneumoperitoneum, and further imaging showed a large perforated ulcer of the superior fornix of the duodenal bulb. Due to the patient’s high preoperative risk, a nonoperative approach was chosen by his multidisciplinary care team. Initial management included nil per os with nasogastric tube decompression, antibiotics, and therapeutic paracentesis. Due to the patient’s declining hemoglobin, an urgent esophagogastroduodenoscopy was performed, and the hemorrhage was treated with epinephrine injection and clipping, followed by placement of a percutaneous pigtail catheter adjacent to the site of perforation. An upper gastrointestinal series completed 11 days later showed no leak from the site of perforation. The patient tolerated dietary advancement and continued to improve until discharge on hospital day 36. In this case, a nonoperative approach yielded resolution of the patient’s bleeding perforated ulcer and resulted in a favorable outcome for our patient.

References

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Cover of Translation: The University of Toledo Journal of Medical Sciences, Volume 16, Issue 2 (2026). The cover features a layered green collage design with the journal title "Translation" in large tan lettering across the top and the full journal name set within a darker green panel. The central artwork shows three overlapping human silhouettes in cream, tan, and brown tones layered with circular medical imaging insets - an ultrasound image and a chest radiograph. A gold DNA double helix runs vertically along the right edge, and a honeycomb hexagonal pattern textures the background, with the volume and issue designation ("Vol. 16, No. 2 (2026)") displayed in a rounded tan banner in the lower right corner.

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Published

2026-10-28

How to Cite

1.
Dunseith S, Hill DS, Yadav DK. Nonoperative Management of a Perforated Peptic Ulcer in the Setting of Decompensated Alcoholic Cirrhosis: A Case Report. Translation [Internet]. 2026 Oct. 28 [cited 2026 Oct. 30];16(2). Available from: https://openjournals.utoledo.edu/index.php/translation/article/view/1698

Issue

Vol. 16 No. 2 (2026): Volume 16, (2026)

Section

Case Reports

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Copyright (c) 2026 Sam Dunseith, Dr. Sarah Hill, Dr. Kunal Yadav (Author)

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