Fatal penetrating and perforating peptic ulceration

Fatal complications of peptic ulcer disease usually involve either perforation or hemorrhage. The case of a 27-year-old female is reported who was found dead at her home address. The autopsy revealed a perforated pyloroduodenal ulcer with localized abscess formation in the lesser sac behind the stomach and established peritonitis. In addition, there was significant hemorrhage with filling of the stomach with fresh blood and the intestine with large amounts of fresh blood and melena. Death was caused by the synergistic effects of both sepsis and significant upper gastrointestinal hemorrhage due to a perforating and penetrating peptic ulcer. Rarely cases of upper gastrointestinal disease may involve more than one fatal mechanism.