THE CONCOMITANT occurrence of duodenal perforation and hemorrhage, while not extremely rare,1 is particularly lethal.2 Recent experience with such an instance in a cirrhotic patient emphasizes the seriousness of this combination. For this reason the following case report is submitted, with a brief mention of certain clinical and experimental considerations.
Report of a Case
This 54-year-old white man was hospitalized Dec 16, 1966, complaining of a sudden onset of sharp, severe, suprapubic pain radiating throughout the whole abdomen. There was no nausea, vomiting, colic, or prior attacks. He had a history of hypertension and cirrhosis. The patient seemed fairly comfortable, phlegmatic, and had a slight icteric tint to the sclerae. The liver was down three or four fingers' breadth. The flanks were dull to percussion. Bowel tones were present and quiet. A rectal examination was essentially negative. Rales were present at the lung bases. The temperature on entry