The perforation (rupture) of a gastric ulcer requires immediate medical attention, because the stomach contents are released into the peritoneal cavity or into the gastric space. what are the causes and symptoms of gastric ulcer rupture? How is gastric perforation treated?

The perforation (rupture) of a gastric ulceris most often a serious complication of gastric ulcer disease, but as much as 15% of perforated gastric ulcers are cancerous. The incidence of gastric ulcer perforation is constant at approximately 0.2% per year. The peak incidence is observed in the elderly, with a definite advantage in men.

A stomach ulcer develops as a result of an imbalance between the damaging effects of secreted hydrochloric acid and pepsin and the mucous membrane's defensive abilities. It is a defect in the mucosa, which also includes its muscular layer and even the deeper layers of the stomach wall. It is characterized by pains immediately after eating food or pains related to food.

The main causes responsible for the development of gastric ulcers are:

  • infectionHelicobacter pylori
  • use of non-steroidal anti-inflammatory drugs
  • Zollinger-Ellison syndrome (very rare)
  • primary hyperparathyroidism (very rare)

The risk factors for developing gastric ulcer include:

  • alcohol
  • smoking
  • steroid therapy
  • stress
  • major surgical procedures
  • occurrence of diseases such as alcoholic cirrhosis, chronic renal failure or chronic obstructive pulmonary disease

A stomach ulcer can perforate the stomach wall. The contents of the stomach are then released into the peritoneal cavity or into the perigastric space limited by adhesions that have developed in the course of inflammatory changes accompanying the ulcer.

Gastric Ulcer Perforation: Symptoms

A typical symptom of gastric ulcer perforation is a sudden, constant and severe epigastric pain, usually accompanied by vomiting, as well as the board-like tension of the abdominal wall. The patient is in serious condition, is lying on his back, avoids movements and gradually develops symptoms of shock.

Physical examination reveals a weakened peristalsis, a tympanic protrusion over the liver, and symptoms of peritonitis. The blood count shows leukocytosis and sometimes elevated serum amylase levels as a result of absorption of the contents from the peritoneal cavity into the blood. On a standing chest X-ray, air may be present under the diaphragm dome or in a network bag. If it is not possible to take the photo in this position, it is taken in the supine position (the so-called left-side photo) - then the air will be visible above the liver.

It is worth remembering that the opening after the perforation of the gastric ulcer can be closed by the net. In such a situation, the patient's symptoms are less severe - severe pain that suddenly appears gradually diminishes, and the patient's general condition improves.

The differential diagnosis of gastric ulcer perforation includes:

  • acute pancreatitis
  • acute cholecystitis
  • acute appendicitis with perforation
  • colonic diverticulitis
  • myocardial infarction

It is very important to take samples from the bottom and area of ​​the ulcer to exclude the presence of a malignant tumor.

Gastric Ulcer Perforation: Treatment

Initially, intravenous fluid administration, nasogastric tube placement, and food suspension are used. Monitoring of vital signs such as pulse, peripheral blood pressure, temperature, oxygen saturation, and diuresis should be initiated after patient catheterization. In addition, it is recommended to administer an antibiotic (e.g. cefuroxime, metronidazole), a proton pump inhibitor and to institute appropriate analgesic treatment.

The prognosis depends on the patient's age, perforation site, and treatment delay.

It is worth knowing that in the case of gastric ulcer perforation, the most important thing is to decide on surgical treatment. Typically, an upper midline laparotomy is performed. If the perforation is not visible, open the net bag and check it.

Thorough rinsing of the peritoneal cavity is essential, and postoperative drainage is not necessary as long as suturing the perforation is secure and careful peritoneal lavage has been performed.

Important

Symptoms of stomach ulcers that require immediate medical attention

There are several symptoms of peptic ulcer disease that are dangerous, and if they do, you should call an ambulance or go to the emergency room.

  • Bleeding fromgastrointestinal tract . They can take the form of bloody or coffee grounds like vomit or tarry stools. These symptoms indicate ulcer bleeding, for example because the damaged mucosa exposes a blood vessel. Then the endoscopic doctor can close the bleeding vessel. This should be done as soon as bleeding occurs, as prolonged or repeated bleeding can lead to anemia.
  • Sudden, very severe upper abdominal pain . Often such symptoms are accompanied by gastrointestinal hemorrhage. The situation is alarming. You have to go to the hospital immediately, because most likely there wasgastric ulcer perforation , i.e. a rupture of the stomach wall. This condition leads to peritonitis very quickly and is even life-threatening. Requires the intervention of a surgeon.
  • Frequent profuse vomiting . These symptoms may suggest stenosis of the pylorus, the part of the stomach surrounded by the sphincter muscle that connects the stomach to the rest of the digestive tract. Pyloric stenosis is often the result of scarring gastric ulcers. The disease impedes the movement of food, makes it stay in the stomach for too long, expands it and causes vomiting. Treatment consists of surgical removal of the pylorus and narrowing of the dilated part of the stomach and gastrointestinal anastomosis.

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