Nausea, Vomting postprandial for 3 days
No former ulcer anamnsesis.
Rheumatoid arthritis with corticosteroide therapy
Nicotine abuse

Examination findings:
smooth abdomen, no pressure pain, unremarkable intestinal sounds

Laboratory: unremarkable

Sonography: Atypical wall thickening and air distribution in area of bulbus duodeni

EGD:  Perforated florid ulcus ventrikuli into bulbus duodeni with bleeding from edge region of the ulcer. No ulcers in bulbus

EGD-Control after 14 days shows a wide, almost completely healed perforation area which is well passable with an endoscope.