What Is a Perforated Peptic Ulcer?

Gastric perforation is one of the most serious complications in patients with ulcers. The most common cause of gastric perforation is caused by overeating on the basis of gastric ulcer. Overeating can cause gastric acid and pepsin to increase, increase gastric volume, and easily induce gastric perforation. Sudden abdominal pain occurs suddenly in the patient. The pain first begins in the upper abdomen or the perforated area, and often appears as a knife-cut or burning pain, which is usually persistent, and the pain quickly spreads to the entire abdomen.

Basic Information

English name: gastricperforation; stomachperforation
Visiting department: Abdominal surgery

Common causes: Peptic ulcer
Common symptoms: Abdominal pain, shock, nausea, vomiting, etc.
Contagious: no

Causes of gastric perforation

The most common cause of gastric perforation is peptic ulcer. As the ulcer continues to deepen, it penetrates the muscular layer, the serosa layer, and finally penetrates the stomach or duodenal wall to cause perforation. Several different consequences can occur after perforation. Such as chronic perforation, a few cases may have gastrocolonic fistula, most of which occur in the gastric and duodenal posterior wall ulcer perforation. If the ulcer perforation quickly adheres to the greater omentum or nearby organs, an abscess around the perforation can be formed.

Clinical manifestations of gastric perforation

Abdominal pain

Sudden abdominal pain occurs suddenly. The pain first begins in the upper abdomen or the perforated area. It often presents as a stabbing or burning pain. It is usually persistent, but it can also be paroxysmal. The pain quickly spreads to the entire abdomen and can spread to the shoulders with a tingling or sore sensation.

2. Shock symptoms

The condition progresses to bacterial peritonitis and intestinal paralysis, and patients may develop toxic shock.

3. Nausea and vomiting

Some patients may have nausea and vomiting, but they are not severe. In the case of intestinal paralysis, vomiting becomes worse, and they also have abdominal distension and constipation.

4. Other symptoms

Fever and fast pulse, but generally appear within hours after perforation.

5. Physical examination

Abdominal wall tenderness, rebound pain, muscle tension and other symptoms of peritoneal inflammation, manifested as a plate-shaped abdomen, liver dullness area reduced or disappeared.

Gastric perforation

1. Abdominal puncture to extract purulent fluid is helpful for diagnosis.

2. X-ray examination, especially in the standing abdominal plain film, usually can find free gas under the diaphragm.

3.B-ultrasound, CT examination can help confirm the diagnosis.

Gastric perforation diagnosis

A diagnosis can be made based on symptoms, signs, and other auxiliary tests.

Gastric perforation complications

Shock

Severe chemical irritation after perforation can cause shock symptoms. The patient showed signs of irritability, shortness of breath, fast pulse, and unstable blood pressure. As the degree of abdominal pain decreases, the situation may stabilize. Since then, with the worsening of bacterial peritonitis, the condition has deteriorated, and severe (infectious) shock can occur.

2. Acute peritonitis

The whole abdominal muscles are tense, plate-like, tenderness is significant, refusal to press, rebound pain.

Gastric Perforation Treatment

The seriousness of gastric perforation is that a large amount of gastrointestinal fluid flows into the abdominal cavity after perforation, causing chemical or bacterial peritonitis and toxic shock. If not rescued in time, it can be life-threatening. There are no small perforations and fasting perforations of peritonitis. Conservative therapy, fasting, placement of nasogastric tubes to suck stomach contents, infusion of water and electrolytes, and antibacterial drugs to prevent secondary abdominal cavity infection can be used. Perforation after full meal, often with diffuse peritonitis, emergency surgery needs to be performed within 6 to 12 hours. Chronic perforation progresses slowly. Perforation to adjacent organs can cause adhesions and fistulas, and often requires surgical treatment.