Perforated gastric ulcer – a complication that occurs after suffering an acute peptic ulcer or chronic ulcer. Since perforation refers to end-to-end damage, a characteristic sign of the disease is that it can lead to the connection of these parts of the gastrointestinal tract with the abdominal cavity. Against the background of exposure to chemical and bacteriological stimuli, peritonitis is formed and develops, which requires urgent medical intervention. That is why such a disorder can be a serious threat to human health. This complication of peptic ulcer occurs in every tenth patient.
Perforation can occur at any age, even in children under ten years of age and in people of advanced age. But in most cases, affects people of middle age from twenty to forty years. In the international classification of diseases (ICD-10), this disorder has its own code K25. The main signs by which the disease is determined are a significant increase in body temperature, frequent gagging, and rapid heartbeat.
It is possible to diagnose ailment with the help of a thorough hardware examination of the abdominal organs. The treatment is carried out mainly with the help of surgical operations, in particular, with closure, additional medication and careful adherence to a special diet throughout life.
The main factor in the development of this pathology is the presence of acute or chronic peptic ulcer disease in humans. In second place in terms of the occurrence of perforated gastric and duodenal ulcers is infection of the gastrointestinal tract with the bacterium Helicobacter pylori. More rare factors include:
- circulatory disorders;
- severe diseases of the respiratory system, which lead to circulatory failure in other internal organs;
- violation of work and sleep. It is noted that ulcer perforation is observed after frequent cases of interrupted sleep, in particular when working on night shifts;
- long-term use of certain anti-inflammatory drugs;
- poor nutrition. It is for this reason that patients are assigned a special diet;
- prolonged exposure to stressful situations;
- the presence of a person’s mental disorders;
- alcohol and nicotine abuse over the years;
- genetic predisposition to violations of the integrity of the mucous membrane of the duodenum and stomach;
- reduced immunity in the background of an inflammatory or infectious process;
- any chronic disease of the digestive tract.
In case of gastric ulcer, perforation can be caused by a number of the following reasons:
- exacerbation of the underlying disorder;
- after eating large amounts of food, which leads to excessive filling of the stomach;
- failure to follow a diet, for example, when eating spicy or salted foods;
- increase the acidity of gastric juice;
- sudden great physical exertion.
According to etiological factors, perforation of gastric and duodenal ulcers occurs from:
- perforation against the background of recurrence of a chronic disease;
- a similar process, due to acute peptic ulcer disease;
- the presence of a malignant neoplasm in these organs;
- exposure to bacteria;
- circulatory disorders due to blood clot.
At the place of localization of the disease is divided into:
- gastric ulcer – the front or back wall, as well as on the body and curvature of the stomach;
- Duodenal ulcer. Ulcers can be of two types – bulbar and post-bulbar.
Depending on the clinical manifestations, gastric and duodenal ulcers can be:
- classical – a breakthrough occurs in the abdominal cavity;
- atypical – the contents are poured into the retroperitoneal space or gland;
- perforation with bleeding.
In addition, ulcer perforation proceeds in several stages:
- easy – its duration is not more than six hours after the break. This phase is characterized by the ingress of gastric juice into the abdominal cavity, which causes its chemical damage. Outwardly, this is manifested by such a symptom as sudden and intense pain in the abdomen;
- middle – the time of its manifestation from six to twelve hours after perforation. It is characterized by intense exudate secretion, against the background of which the painful sensations decrease;
- heavy – the time of its progression takes from twelve hours to one day from perforation. At this stage, peritonitis and abscesses begin to form. If you do not promptly go to a medical facility for treatment, the death of a person can be an outcome.
In turn, peritonitis also manifests itself in several forms:
- chemical – or primary shock phase;
- inflammatory, externally may manifest imaginary reduction in symptoms;
Perforated gastric and duodenal ulcer is always manifested by the occurrence of sudden and unbearable pain in the abdomen. With the transition from one stage of disorder to another, the symptoms of perforated gastric ulcer begin to develop:
- persistent nausea and frequent gagging;
- pallor of the skin;
- cold sweat;
- the spread of pain to other parts of the abdomen and upper limbs;
- a sharp and significant increase in body temperature, up to fever;
- tension of the abdominal muscles – the slightest touch to this area causes unbearable pain in a person.
In the early stages of perforation, the symptoms are expressed quite strongly, but a person can suppress them by adopting a specific posture. To do this, lie down on your right side, and press your legs as close as you can to your knees bent. After the manifestation of the primary symptoms, the disease proceeds to the next stage, when the person becomes much easier, he feels only a slight pain in the abdomen. But, in a day from the perforation, the condition of the victim deteriorates sharply, an acute manifestation of all the above symptoms is observed.
Diagnostic measures for perforation of gastric and duodenal ulcers make up a whole range of tools that will help the specialist to prescribe the correct treatment tactics. Thus, the diagnosis consists of:
- collection of clinical data, which includes the determination of the time of expression of symptoms of perforated gastric ulcer. The tactics of treatment depends on how quickly a person turns for help;
- direct examination by a specialist and palpation of the abdominal cavity. The intensity of the pain will let the doctor know at what stage the disease is;
- X-ray – so it is possible to determine the air in the digestive tract;
- endoscopic examination – is carried out in cases where X-ray did not give results, but the doctor still has suspicions of perforation of the ulcer of the stomach or duodenum. Allows you to detect the location of the tumor;
- ECG – is conducted on a mandatory basis, to assess the work of the heart and to detect cardiac arrhythmias;
- Ultrasound – indicates the place of formation of abscesses after perforation;
- diagnostic laparoscopy – is carried out with the explicit expression of symptoms of irritation of the abdominal cavity, to confirm the source. There are several contraindications for such an examination – an excessively high body mass, problems with blood clotting, the formation of large hernias, the patient’s difficult condition;
- laboratory studies of blood tests for peritonitis or bacteria.
After receiving all the results of the examination, the specialist prescribes the most effective treatment tactics and makes a sparing diet.
The main goal of treatment for perforation of gastric and duodenal ulcers is the elimination of the underlying disease and the preservation of the patient’s life. Since this disease is an emergency, emergency medical care for this disease can be done in several ways:
- conservative techniques;
- the appointment of proper nutrition.
The first method of treatment is carried out in case of impossibility or unwillingness of the patient to perform the operation. Conditions for the implementation of such therapy are – the age of the victim should not be more than seventy years, after the perforation should take no more than twelve hours. The basis is the appointment of antibiotics and anesthetic medicines, the use of antisecretory drugs, as well as substances aimed at eliminating Helicobacter pylori.
Treatment with medical intervention in most cases is carried out by several operations – suturing, resection of the stomach, excision of a perforated ulcer. The choice of which surgical method to assist the patient depends on such indicators as: time of expression of symptoms, location, cause of occurrence, presence of peritonitis, age category and general condition of the patient.
Sewing of perforated ulcers is carried out in the presence of peritonitis. The time after perforation should be no more than six hours. Such an operation is performed for middle-aged people with acute peptic ulcer disease. The technique of the surgical method of treatment consists of cutting the ulcer and stitching the muscle and serous membrane with a longitudinal suture. At the end, a control examination of the abdominal cavity and the installation of temporary drainage are carried out. In some cases, suturing is performed using laparoscopic equipment.
Treatment using gastrectomy or duodenal ulcer is carried out only when large volumes of ulcers are diagnosed, oncology is suspected, the patient does not reach the age of sixty-five years, the time after peritonitis is from six to twelve hours. Such treatment tactics is complicated by the fact that the operation can lead to disability.
Excision of minimally invasive methods of perforation of gastric and duodenal ulcers using laparoscopy and endoscopy is prescribed for the localization of the tumor on the anterior wall of the organ, with minimal inflammatory process. In addition to removing the ulcer, the ligation of the vagus nerve, which is responsible for the nervous stimulation of this organ of the gastrointestinal tract, is carried out during the operation.
In addition to treatment with operable intervention, a special diet is also prescribed. Diet provides an exception from the diet:
- alcoholic and sweet carbonated drinks;
- too hot, salted or spicy foods;
- garlic, onion and radish;
- citrus fruits;
- smoked sausages;
- chips and crackers;
- chocolate and ice cream;
- sweet breads.
During the diet you can eat:
- boiled eggs or omelets;
- broths made from lean meats and fish;
- dairy products with a low percentage of fat;
- vegetables, except for prohibited;
- oatmeal, buckwheat and rice cereals.
Patients need to adhere to proper nutrition in order to avoid a recurrence of the disease.
The only means of preventing perforation of gastric and duodenal ulcers are timely treatment of the underlying disease and diet.