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Duodenal Ulcer

Duodenal Ulcer

If your duodenal ulcer was negligently managed, causing you to suffer unnecessary complications, you could be entitled to pursue a medical negligence compensation claim. Please get in touch with us to find out more.

What is a duodenal ulcer?

A duodenal ulcer can also be referred to as a peptic ulcer. It is when an open sore develops on the lining of the duodenum, which is the first section of the small intestine.

Around 95% of duodenal ulcers are caused by an infection by the Helicobacter pylori bacteria. Excessive use of non-steroidal anti-inflammatory medication (NSAIDs) can also cause a duodenal ulcer. Other factors that may contribute towards a duodenal ulcer developing include: smoking, alcohol, aspirin, steroids and stress.

Symptoms of a duodenal ulcer

The most obvious symptom of a duodenal ulcer is a burning pain in the centre of the abdomen. This pain may temporarily diminish after eating. Other symptoms include:

  • Nausea
  • Bloating of the abdomen
  • Heartburn
  • Dark, tar-like stools

Diagnosing a duodenal ulcer

When a patient presents to their GP with these symptoms, he/she should be suspected of having a duodenal ulcer. If a patient is taking NSAIDs, or has a history of taking them, it would be prudent to carry out an endoscopy. This procedure allows doctors to see the lining of the duodenum, and should confirm or rule out a duodenal ulcer.

If a patient is not taking NSAIDs, a doctor may first want to test for the H. Pylori infection. This can be achieved through a urea breath test, blood tests and a stool antigen test. If these tests are inconclusive, a patient should be sent for an endoscopy.

Treating a duodenal ulcer

The mode of treatment for a duodenal ulcer will depend upon the underlying cause. If an infection is to blame, a course of antibiotics will kill the bacteria. If NSAIDs are the cause, a course of proton pump inhibitors (PPIs) will be needed, and a patient's use of NSAIDs must be reviewed. It is possible that a duodenal ulcer is caused by both medication and an infection, in which case both antibiotics and PPIs will be required.

If diagnosed in time, a duodenal ulcer can be effectively treated with medication alone.

What happens if a duodenal ulcer is not treated?

If a duodenal ulcer is not diagnosed and treated, complications will arise. This is more likely to happen in duodenal ulcers caused by NSAIDs because these types of ulcers do not always produce obvious symptoms and are therefore overlooked. The NHS estimates that one in 50 patients with an NSAID-related ulcer will suffer a complication.

Perhaps the most worrying complication is a perforated ulcer. This is when the ulcer becomes so deep that the lining of the duodenum actually splits open. This will affect around one in 350 people with a duodenal ulcer. A perforated ulcer is very serious as the contents of the intestine will spill into the abdominal cavity, infecting the abdomen.

Diagnosing a perforated duodenal ulcer

A patient with a perforated duodenal ulcer will present with an intense abdominal pain which gets progressively worse. There will also be signs of peritonitis (an infection of the lining of the abdomen).

A patient with these symptoms should undergo a chest x-ray, and on the balance on probabilities this will reveal free gas under the diaphragm. A diagnosis of intra-abdominal perforation will then be made and the patient should be referred to the surgical on-call team.

Following admission treatment with intravenous fluids and intravenous fluids and intravenous antibiotics, a patient should undergo a CT scan of the abdomen, which will confirm free intra-peritoneal gas. This should then lead a short while later to a laparotomy being performed and the diagnosis of a perforated duodenal ulcer being made.

If this standard of care is achieved, there will be minimal contamination of the abdominal cavity and there will be no bacterial peritonitis. The perforation will be closed with simple sutures and covered with an omental patch. On the balance of probabilities, the patient will go on to make an uneventful recovery, being in hospital for a week or possibly 10 days.

There is a small chance that a patient will develop a collection or subphrenic abscess but this is a less than 50% chance. Following discharge from hospital a patient may require a period of assistance but should made a full recovery and be able to return to normal activities within six months of surgery, but more probably nearer three months after surgery.

Failure to recognise a perforated duodenal ulcer

If a perforated duodenal ulcer is not quickly diagnosed, a patient will rapidly become critically unwell. Peritonitis and systemic sepsis (an infection of the blood) will arise. Both these conditions are potentially life-threatening and can result in multi-organ failure, including acute renal failure.

Although the perforation may be subsequently diagnosed and sealed, it is likely that a patient will by that time be seriously unwell with signs of systemic sepsis. Even if a patient survives this, he/she will require a long time in the Intensive Care Unit, and multiple laparotomies to repair the perforation and to washout the abdominal cavity. A number of operations may be required.

Spending such an extensive time in the Intensive Care Unit can in itself cause complications. A patient may develop chest problems such as a collapsed lung (pneumothorax). He/she may also develop critical care peripheral neuropathy, whereby the peripheral nervous system is damaged. This will result in permanent side-effects, such as pain in the hands and feet, limited mobility and weakness in the limbs.

Having a near-death experience, and being left with long-term problems, can lead to serious psychological issues.

Duodenal ulcer and medical negligence

If you suffered complications as a result of a duodenal ulcer, it may be that medical negligence is to blame.

For example, if your GP failed to recognise the early symptoms of a duodenal ulcer, meaning it remained untreated, there will be a substandard level of care. If this caused you to sustain further injury such as a perforated duodenal ulcer there will be a case of medical negligence.

The same applies if medical practitioners failed to realise you had a perforated ulcer, and this resulted in life-threatening complications.

Contact a solicitor

To find out if you can claim for a duodenal ulcer, please do not hesitate to get in touch with us today.

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