A perforated ulcer causes peritonitis which gradually involves all intra abdominal organs. Fluid gets collected and infection sets in. This causes increased intra abdominal pressure. Ultimately the diaphragm gets involved making the infection reach pleural cavity and in turn causes pleurisy which is infection of pleura. As a result septicemia sets in and the patient dies.This could be a probable cause of Rudolph Valentino s death. Good to see such an ardent fan!!