The sensitivity of sonography was assessed in an unselected series of 56 patients suffering from complicated gastric (20) or duodenal (36) ulcers. Evidence of ingested material and/or free gas in the peritoneal cavity associated with a pathologic gastroduodenal cockade proves perforation. Ulcer penetration is visible as eccentric "tumour" extension into hepatoduodenal ligament, liver or pancreas, whereas callous ulcer is recognisable as pathologic noninfiltrating cockade, and duodenal obstruction from stomach distention in spite of fasting. Based on these criteria, immediate diagnosis was feasible in 42/56 patients (approximately 75%). Ulcer perforation was confirmed in 20/26 (approximately 77%), including plain x-ray negative cases, which comprised approximately 31% of the perforations in this series. Ulcer penetration and - obstruction and chronic callous ulcers were diagnosed in 22/30 (approximately 73%) patients. Thus, sonography was proven to be highly contributive to immediate diagnostic fact finding and therapy.
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