Penetration of other organs

Five to 10 percent of perforating ulcers may result in erosion into adjacent abdominal organs. Such penetration can involve the pancreas, bile ducts, liver, and the small or large intestine. The pancreas is the most common site of penetration.

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The acute onset of associated complications, such as pancreatitis (inflammation of the pancreas), cholangitis (infection of the biliary tract), or diarrhea of undigested food, may indicate penetration. The diagnosis of penetration is more difficult than that of perforation and is based on a combination of severe ulcer symptoms, atypical pain distribution, and diminished response to the usual therapy. Surgery is usually not recommended in the management of penetration unless complications relating to the bile ducts are present or the underlying peptic disease is severe.