A perforated gastric ulcer is a through damage to the walls of the stomach, which develops on the site of an ulcer.
The condition provokes the development of intense pain in the abdominal area and tachycardia, fever, vomiting. When pathology is shown, carrying out emergency surgical manipulations, which are supplemented with antisecretory, antihelicobacter and detoxification treatment.
What is a perforated stomach ulcer?
Perforation of an ulcer is a deadly complication of peptic ulcer disease, which provokes peritonitis.
Pathology leads to the ingestion of a food lump from the stomach into the abdominal cavity. As a result, a burn of the peritoneum develops, symptoms of shock appear.
The danger of pathology is the development of serous fibrosis, then purulent peritonitis, the rate of occurrence of which depends on the acidity of the discharged substances.
Causes of perforation
The following causes can lead to the development of perforation of stomach ulcers:
- Presence of a peptic ulcer in the anamnesis regardless of the form of pathology;
- Infection of the stomach with the bacterium Helicobacter pylori;
- Development of plaques from cholesterol on vessel walls;
- Severe pathology of the respiratory organs, which causes blood flow disorders in other internal organs;
- Not observance of a mode of work and rest;
- Frequent stressful situations;
- Blood flow disorder;
- Therapy with certain medicines for a long time;
- Unsustainable nutrition;
- Mental disturbance;
- Alcoholism and smoking;
- Hereditary predisposition;
- Decreased immunity against the background of a serious infectious process.
Patients diagnosed with gastric ulcer, perforation develops in the background:
- Period of exacerbation;
- Overeating, which provokes stomach stretching;
- Frequent use of spicy or salty foods;
- Increased acidity of gastric juice;
- Sudden excessive physical exertion.
Symptoms of perforated ulcer of the stomach and duodenum
There are 3 periods of development of the pathology:
- Chemical peritonitis. The duration of the period is 3-6 hours. The time depends on the diameter of the pathological formation and the volume of the stomach contents. This stage is characterized by the development of an acute pain syndrome in the region of the perianopic segment and the right hypochondrium, which eventually spreads to the entire abdomen. If the perforation has occurred on the front wall of the organ, the pain develops on the left side. Also note the development of hypotension, increased respiration, pallor of the skin, increased functionality of sweat glands. Vomiting develops rarely. Characteristic is the accumulation of gases, the musculature of the anterior wall of the abdomen.
- Occurrence of bacterial origin of peritonitis. Within the period there is relaxation of abdominal muscles, elimination of pain syndrome, normalization of respiration. The patient notes the relief of the condition for a while. However, then the temperature rises, heart rate, acute intoxication of the body, which provokes increased gas production, paralysis of peristalsis. Characteristic is the appearance of a gray plaque on the tongue, its dryness. The patient begins to experience euphoria, uncritically refers to his own condition.
- Acute intoxication. The stage develops 12 hours after perforation. The main symptoms: indomitable vomiting, which provokes dehydration, dry skin, tachycardia, a sharp change in body temperature( from 38-40 ° to 36.6 ° C), hypotension( low blood pressure).The patient becomes listless, indifferent, slowly reacts to external stimuli. Gradually, the abdomen increases in volume against the background of increased gas formation. At this stage, the life of the patient is extremely rare.
Classification
Perforation of ulcers is classified according to the clinical picture of the pathology:
- Typical. Characterized by the flow of food from the stomach into the abdominal cavity;
- Atypical. leads to the ingestion of the contents of the digestive organ into the gland or packing box, the intercostal area;
- With bleeding. Pathology leads to the development of bleeding into the abdominal cavity or digestive tract.
According to pathological and anatomical characteristics, perforation is isolated on the background:
- Oncopathology;
- Acute ulcer;
- Blood flow disorders;
- Chronic ulcer;
- Parasitic infestation.
According to the location of the perforation it is customary to isolate the ulcer:
- Stomach;
- Combined ulcer, when perforation develops against the background of the defeat of several digestive organs;
- of the duodenum;
- Pyloradoadenal ulcer.
Diagnosis
If suspected of perforation, ulcers are recommended to carry out complex diagnostic measures. This will help the doctor choose the optimal treatment tactics. Diagnostics involves the following steps:
- Inspection. The doctor should find out the time of development of the initial symptomatology of the disease, then the palpation of the abdomen is performed. The degree of intensity of pain syndrome is a diagnostic criterion that allows to determine the stage of the pathological process;
- Radiography and CT.Helps determine the presence of air in the digestive organs and abdominal cavity;
Photo of a computerized tomography of the perforated stomach ulcer
- Endoscopy. Carried out at low radiography performance. The study will allow to determine the localization of the neoplasm;
- ECG.The procedure helps to assess the functionality of the heart, to detect rhythm disturbances;
- ultrasound. The method helps to identify the presence of abscesses, which develop against the background of perforation of the ulcer;
- Diagnostic laparoscopy. The operation is performed at the appearance of severe perforation symptomatology to determine the location of pathological formation.
Emergency care
If suspected of perforation, the patient's ulcers should be placed in bed, ensuring rest, call an ambulance.
Before transporting the patient to the hospital, probing is carried out to remove food residues from the stomach.
The patient is placed on a stretcher so that the head is slightly raised and the legs are bent. This will reduce the severity of pain. To eliminate signs of shock, the introduction of cardiac or respiratory analeptics is indicated( Strofantina, Cordiamin).
Operation
Therapy of an ulcer perforation involves surgical intervention. The operation should be performed as early as possible, otherwise surgical treatment may be meaningless.
The surgeon selects therapy tactics based on the clinical picture:
- Sewing of small perforation. The operation is indicated in the development of diffuse peritonitis, the duration of the pathological process is no more than 6 hours, in the elderly, in the presence of concomitant pathologies, with acute stress ulcers. Therapy involves excision of the edges of the ulcer with subsequent suturing. This allows you to keep the physiological form of the stomach. With minor peritonitis, the operation is performed laparoscopically;
- Resection of the stomach. Indications for surgical manipulation: giant and gross ulcers, the presence of a tumor with perforation, suspicion of cancer, pyloroduodenal stenosis, age of the patient under 65 years old, duration of the pathology is no more than 12 hours;
- Excision of perforated ulcer with pyloroplasty. The operation is performed with the appearance of perforation on the front wall of the organ, minimal inflammation of the peritoneum. Within the framework of a surgical procedure, the abdominal cavity is sanitized, the branches of the vagus nerve are cut to reduce the intensity of the production of gastric juice;
- Selective proximal vagotomy. It is used mainly in patients of young age in the absence of scars in the stomach.
If there is a massive bleeding in the perforation of the ulcer, then the excision of pathological formation or resection of the stomach is indicated.
This video shows the laparoscopic suturing of the perforated ulcer of the duodenum:
Diet after operation
After performing surgical procedures, dietary nutrition should be strictly adhered to. Postoperative diet involves a dramatic reduction in the intake of carbohydrates, liquid and salt.
For 3 days after the operation, famine is recommended, which will allow the stomach to adapt to the new condition. From the fourth day you can drink a decoction of wild rose, jelly.
On the 5th-6th day you can enter vegetarian soups-mashed potatoes, soft-boiled eggs, mashed rice porridge on the water. A week after the operation, with good health, you can add vegetable purees, chicken cutlets from fish and chicken, steamed. During cooking, you should avoid using oil and salt.
After the operation, the following products are allowed:
- Omelettes for steaming, soft-boiled eggs;
- Dried wheat bread in the oven;
- Soups on vegetarian and light broths( chicken, turkey);
- Low-fat dairy products;
- Cutlets from beef, rabbit and chicken steamed;
- Low-fat fish;
- Vegetables: squash, potatoes, pumpkin, carrots;
- Fruit( pear, banana, apple);
- Groats: buckwheat, rice, semolina, oatmeal;
- A small amount of vegetable oils.
Dietary food involves eating small portions of food up to 6 times a day. All dishes should be puree or liquid consistency, prepare for a couple. It is recommended to follow the diet for 6 months after surgery.
Complications of
The risk of developing negative consequences after surgery increases with every minute of delay during treatment and diagnostic manipulation.
In some cases, after surgery, such conditions develop:
- Occurrence of limited or local peritonitis;
- The inconsistency of the surgical sutures, which leads to a repeated outflow of stomach contents;
- Disturbance of motility of the digestive organs;
- The development of bronchopneumonia in a patient against the background of a constant recumbency.
Forecast
Refusal to perform surgical procedures will lead to the death of the patient within 7 days after the development of perforation.