A perforate ulcer, also known as a bleeding ulcer or a perforated peptic ulcer is a very serious condition where an untreated ulcer can burn through the wall of the stomach (or other areas of the gastrointestinal tract), allowing digestive juices and food to leech into the abdominal cavity. Treatment generally requires immediate surgery. The ulcer is known initially as a peptic ulcer before the ulcer burns through the skin. A diagnosis is made by taking an X-ray of the stomach area (seeking air under the diaphragm). This is in fact one of the very few occasions in modern time where surgery is undertaken to treat an ulcer. Many of the perforated ulcers have been attributed to the bacterium Helicobacter pylori. The incidence of perforated ulcer is steadily declining, though there are still incidents where it occurs. Causes include smoking and non-steroidal anti-inflammatory drugs (NSAIDs). A perforated ulcer can be grouped into a Stercoral perforation which involves a number of different things that causes perforation of the intestine wall.