Doctors unanimously confirm the fact that perforated duodenal ulcer is the peak complication of the disease under consideration. Pathology goes to the extent when perforation through the perforation walls occurs and the intestinal contents can enter the retroperitoneal space or go directly to the abdominal cavity. Most often, a perforated ulcer of the duodenum is formed in the anterior wall of the bulb of the initial sector of the small intestine.
The age range of patients with this diagnosis varies from 20 to 40 years, although the diagnosis of a serious complication can be recognized in patients who do not fall within this framework. The difficulty in establishing the diagnosis is that the perforated ulcer of the duodenum is more characterized by the asymptomatic course of the disease.
Another important fact - the perforation of the duodenal ulcer provokes the dispersal of the pathological process into adjacent organs through the defect. And most often the patient does not cause restless clinical signs.
Set of symptoms of perforation of duodenal ulcer
In medical practice, the symptoms of perforated duodenal ulcer are divided into several stages of development, depending on the location, causes and forms of perforation.
Classification of symptoms:
- for etiology - chronic mute and acute perforation;
- at the site of distribution - bulbar perforated ulcer dpk, which is located on the anterior or posterior walls of the bulb, and postbulbar perforated ulcer dpk, developing outside the bulb;
- on the clinical form - perforation of the back wall of the duodenum, perforation in the abdominal cavity, multiple kissing and mirrored through defects.
Three phases of the clinical periods of the disease with individual characteristic symptoms are also recognized:
- The first phase is a sharp piercing pain in the epigastric region. During the first 6 hours, the patient may experience vomiting, and any movement provides acute pain. The lower extremities brought to the stomach in the position on the side, partially relieve discomfort. The skin becomes pale, cold bouts of sweat are possible. Palpation determines the stiffness of the abdomen.
- The second phase brings temporary relief. A few hours after a severe attack, the patient's condition stabilizes, the spasm of the muscles of the abdominal wall passes, the pain is blunt. The patient's body temperature gradually rises, thirst is tormenting, flatulence begins. These symptoms indicate the initial stage of inflammation of the abdominal cavity due to ingestion of food masses through the damaged intestine. Here palpation determines the highest soreness in the right hypochondrium.
- The third phase occurs one day after perforation of the duodenal ulcer. The patient's condition deteriorates sharply. The first symptom is systematic vomiting. Low blood pressure and rapid breathing indicate a high temperature and dehydration of the body. At this stage, surgery can already be a belated measure of intensive care.
Signs of perforated duodenal ulcer
Diagnosis of perforation of the ulcer ddk relies on information obtained during the questioning of the patient, as well as data from the instrumental survey. The anamnesis of the disease in most cases contains complaints from the GIT system. All signs of perforated ulcers are divided into two types:
- basic - acute pain, muscle spasm, symptoms are characteristic of the disease;
- secondary - functional and general physical disorders.
Approximately a third of the total number of patients are admitted to inpatient treatment with a dyspnoeal piercing ulcer against a background of complete health. The so-called mute perforation can be detected exclusively by X-ray endoscopic examination of the abdominal cavity. The location of erosive defects by indirect signs indicates the localization of perforation.
Often the patient's condition rapidly deteriorates and it becomes impossible to collect clinical analyzes and instrumental studies. In such cases, there is a risk of ineffective surgical intervention in the intestinal system. Therefore, it is important to distinguish the perforated ulcer of the duodenum from the acute pathologies of the upper abdominal sector.
Treatment of perforating ulcers of ddk
If the specialist confirms the presence of a perforated ulcer of the duodenum, the operation is unavoidable. If a patient refuses a surgical intervention, the doctor will prescribe conservative therapy, but the statistics indicate a low percentage of the positive outcome in the presence of severe complications.
Methods of surgical treatment:
- Suturing is the simplest and most common type of operation. The edges of perforation are excised, and the defect is sutured by two rows of seams, linking the muscle and mucous epithelium. At the same time, the physiological parameters of the organ are preserved;
- Excision is an operation method that involves the complete removal of end-to-end defects, especially large ones in diameter. In addition to surgical intervention, measures are taken to drain the abdominal cavity;
- Resection is a radical intervention in the physiological form of the intestine by removing a specific part of it. It is a disabling operation, but it gives a person a chance to survive;
- Vagotomy - excision of a perforated defect with pyloroplastic reconstruction of the DPC.