PERFORATION AND HEMORRHAGE FROM DUODENAL ULCER DURING THE ADMINISTRATION OF RAUWOLFIA SERPENTINA: REPORT OF FIVE CASES

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Abstract
Five proved cases of complicated duodenal ulcer were presented. All patients were taking Rauwolfia serpentina when these complications developed. The time intervals from institution of therapy to perforation or hemorrhage were 4, 7, and 13 days, 6 months, and over one year. There were 4 white males and 1 white female in this series, all over age 50. Four gave a fairly definite history of ulcer. There was one death. These cases represented 11.9% of all the perforations and hemorrhages from duodenal ulcer at our 250 bed general hospital, over a 1.5 year period. Rauwolfia serpentina causes a prompt and sustained rise in gastric acidity due to peripheral or humoral action. Apparently there is a causal relationship between these agents and the occurrence, recurrence, and complications of duodenal ulcer. Rauwolfia serpentina is contraindicated in patients with duodenal ulcer, and utilized with caution in others, especially those with a past history of ulcer diathesis. Whenever such therapy is initiated, the potential rise in gastric acidity should be buffered with between meal feedings and/or antacids. If gastrointestinal symptoms develop during the course of therapy, the agent should be stopped and the patient evaluated clinically and if possible roentgeno-graphically. If a patient is unable to give an adequate history, another antihypertensive or tranquilizer should be used.

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