Perforation of the stomach: symptoms, treatment, complications

Among all chronic diseases of organs located in the abdominal cavity, perforation of the ulcer of the stomach and duodenum is approximately 2%. According to statistics, the incidence of this complication of the disease is 7-12% and occurs in patients whose age is 25-35 years. In men, it appears 5 times more often, unlike women.

Causes of perforation

Perforation of the stomach (perforation) occurs with a decrease in the nutrition of the bottom of the ulcer and the edges of the tissues. It occurs with different dysfunction of the patency of the vessels through the arteries. This explanation is proved by the fact that at the time of perforation, there is no bleeding at the site of the lesion of the duodenum or the stomach wall. Perforation of the stomach ulcer has 3 forms:

• Typical (the contents of the stomach flow into the abdominal cavity, develops peritonitis);
• Atypical (perforation is covered by food, omentum, mucous folds, etc.);
• In the form of pentration (the bottom of perforation opens into neighboring organs).

As a rule, this phenomenon is preceded by a strong pain syndrome, characteristic of a peptic ulcer, which lasts for a long period. In this case, the walls of its base can decay. Perforation of the stomach can be caused by:

• Emotional and physical stress;
• The use of alcohol;
• Exacerbation of peptic ulcer disease;
• Overeating;
• Injury;
• Treatment with certain drugs that cause such a pathology.

It is necessary to pay attention, that at the elderly in the anamnesis of an ulcer can not be, as for these patients the latent picture of illness is characteristic.

What provokes perforation

As a rule, acute ulcers in no way are associated with H. pylori infection. Confirmation of peptic ulcer in 95% indicates its Helicobacter pylori etiology. Acute ulcer can be considered as a stage of gastric ulcer. In addition to H. pylori, gastric perforation can be provoked:

• The Zolinger-Alison syndrome;
• Medicinal ulcers and other endocrine diseases;
• Pancreatogenic, hepatogenic and other varieties of acute ulcers (eg, Crohn's syndrome).

For the appearance of an opening in the gastric wall, great importance is its destruction in all layers of hydrochloric acid and an increase in pressure in the abdominal region. Performative chronic ulcer is considered to be a stage in the progression of gastric ulcer. This pathology is formed during the absence of necessary therapy.

Symptoms of the disease

Perforation of the stomach wall has 3 main stages:

1. Shock condition.
2. False well-being.
3. Peritonitis.

Immediately the stage of shock occurs during perforation and ingestion of gastric contents on the peritoneal sheets. A person feels an unbearable "dagger" pain, which appears in the upper layers of the abdominal cavity, which quickly spreads to the whole area of the abdominal cavity. Most patients at this moment begin to rush and scream. The overall severity of the condition is rapidly increasing:

• The pressure decreases;
• The pulse slows down;
• Skin covers become wet, cold and pale;
• The patient takes a forced posture - on his side, with knees brought to his stomach.

After a certain period of time (about 7 hours) the pain is weakened, and in some cases completely disappears. Slowly the bloating rises, it becomes not so tight, the noise in the intestines disappears with auscultation. Arterial hypotension is preserved, arrhythmia begins to appear and tachycardia increases. The time of the false well-being phase can reach up to 12 hours.

Possible consequences

During the two previous stages, the person gradually develops peritonitis. The degree of the condition is again aggravated: the patient is inhibited, the skin covers acquire an earthy tint, become sticky with sweat. The anterior wall of the peritoneum is tense. The volume of produced urine decreases substantially, sometimes even reaches anuria.

If the patient has a stomach ulcer of an atypical form, perforation is possible in the retroperitoneal tissue. In addition, the hole may be covered by food or surrounding organs. It is possible to limit the process in the presence of many adhesions. There are several types of perforation cover:

• Constant;
• Long-term;
• Short-term.

Such types of perforation proceed, as a rule, much easier. Cases of self-healing are known.

In addition to peritonitis, hypovolemia, shock and sepsis can complicate the passage of the stomach disease.

Diagnosis of the disease "gastric ulcer"

Perforation of the stomach requires an accurate diagnosis, which can be established solely on the correctly collected anamnesis. To diagnose the disease, you should always contact a specialist. Gastroenterologists and endoscopists are engaged in such problems.

It is very important to be screened in time, if there is a suspicion that you have a stomach perforation. Symptoms should never be ignored, since a neglected stage of the disease can lead to irreparable consequences. An appeal to an endoscopist and a gastroenterologist is absolutely required for every patient with suspected disease, especially when there is a probable presence of a closed perforation. However, the studies do not show full-fledged data for diagnosis, but they need to be carried out as part of the preparation for a surgical operation.

Perforation of the stomach is determined in such ways:

• Survey radiography.
• Ultrasound of the abdominal cavity.
• Esophagogastroduodenoscopy.
• When complicating the diagnosis and suspicion of a covered perforation, laparoscopy is used.

Diseases with similar symptoms

Perforation of the stomach can be referred to such concepts as "acute abdomen", therefore this disease must be differentiated with:

• Pancreatitis;
• Cholecystitis and appendicitis;
• Tumor decay;
• Renal and hepatic colic;
• Thrombosis of mesenteric veins;
• Rupture of aneurysm of the aorta in the abdominal cavity;
• A heart attack;
• Pleurisy.

Timely reference to a specialist and conducting diagnostic measures will help to establish an accurate diagnosis and start treatment of a dangerous disease on time.

How to cure perforation?

Depending on the clinical picture, help with the perforation of the stomach, turns out to be several methods.

1. Usual suturing ulcers. It is made for young people without an anamnesis of ulcers, elderly patients with an increased risk of anesthesia and surgical care, as well as with the existing diffuse peritonitis.
2. If there is no peritonitis, this intervention can be supplemented with proximal selective vagotomy, which makes it possible to prevent prolonged treatment in the ward of gastroenterology in the future.
3. In the presence of an ulcer in the pyloric department, penetration of the ulcer, significant bleeding, stenosis of the exit tract, as well as weakened people with a significant risk of surgical operation, excision is performed, pyloroplasty and stem vagotomy.
4. When the patient has a mixed appearance of a peptic ulcer or if there are indications for additional gastric perforation, this surgical operation can be supplemented with hemigastrectomy.
5. Excellent results are available against laparoscopic and endoscopic therapy. Endoscopic vagotomy and endoscopic treatment will be able to supplement the surgical intervention of the perforation of the stomach.

If it is necessary to reduce the risk of surgical intervention, distal gastrectomy or laparoscopic tamponade of the perforation may be possible with the gland site. These manipulations are best tolerated by patients, which can provide recovery in a much faster time.

After performing the surgery, an indispensable condition for complete correction of the patient is the abolition of non-steroid drugs (when the appointment allowed the appearance of a gastric ulcer) or their change to inhibitors of cyclooxygenase, as well as conservative eradication.

Prevention and Forecasting

During the perforation, the prognosis is quite severe, since untimely diagnosis of this condition sometimes leads to a lethal outcome of the patient. Among the young men, the lethal outcome is about 2-6% (taking into account the clinical picture, the time of care provided and some other factors), in elderly people this coefficient is increased several times.

Prevention of the disease is secondary - you need to make a timely diagnosis and treat those diseases that could bring the patient to this state.