Secondary ulcer perforation after endoscopic blood-staunching with fibrin sealing

Emergency treatment of bleeding ulcer of the duodenum is endoscopy and endoscopic blood-staunching. In high-risk patients with Forrest Ia lesions or ulcers with visible vessel (Forrest Ia) endoscopic follow-up or early elective operation is required. Fibrin sealing can improve the results of endoscopic injection therapy for bleeding ulcer. Nevertheless, severe complications such as secondary perforation of the fibrin clot or recurrent bleeding can occur. Identification of highrisk patients and complications requires close monitoring and attention. A case of a secondary perforation of a bleeding ulcer of the duodenum after fibrin sealing is reported.