Most patients have a history of ulcers, with symptoms worsening several days prior. Perforation often occurs suddenly at night, either on an empty stomach or after a heavy meal. The typical symptom is a sudden, intense upper abdominal pain, described as sharp like a knife, which may radiate to the shoulder and quickly spread throughout the abdomen. Patients often exhibit pale complexion, cold sweats, cold extremities, and a weak pulse, indicative of shock, accompanied by nausea and vomiting. Due to secondary bacterial peritonitis, abdominal pain may intensify. Patients assume a forced posture, with shallow breathing and often a high fever. There is tenderness throughout the abdomen, with rebound tenderness most pronounced in the upper abdomen, leading to a rigid, board-like abdomen. Percussion reveals a reduced or absent liver dullness, and shifting dullness may be present. Auscultation shows absent or significantly diminished bowel sounds.