Among all chronic diseases of organs located in the abdominal cavity, perforation of a stomach ulcer and duodenal ulcer is approximately 2%. According to statistics, the frequency of this complication of the disease is 7-12% and occurs in patients whose age is 25-35 years. At the same time, it appears in men 5 times more often, unlike women.
Causes of perforation
Perforation of the stomach (perforation) appears with a decrease in nutrition of the bottom of the ulcer and tissue edges. It occurs with various dysfunctions of vascular patency through arteries. This explanation is proved by the fact that during perforation there is no bleeding at the site of damage to the duodenum or stomach wall. Perforation of a stomach ulcer has 3 forms:
- typical (the contents of the stomach pour into the abdominal cavity, peritonitis develops);
- atypical (perforation is covered by food, omentum, folds of the mucosa, etc.);
- in the form of pentration (the bottom of the perforation opens to neighboring organs).
As a rule, this phenomenon is preceded by a strong pain syndrome characteristic of peptic ulcer disease, which lasts for a long period. In this case, the decay of the walls of its base is possible. Perforation of the stomach can be caused by:
- emotional and physical stress;
- drinking alcohol;
- exacerbation of peptic ulcer disease;
- overeating;
- trauma
- treatment with certain drugs that cause such a pathology.
It should be noted that older people may not have a history of ulcers, since these patients have a latent picture of the disease.
What provokes perforation
As a rule, acute ulcers in no way bind to H. pylori infection. Confirmation of a peptic ulcer in 95% indicates its Helicobacter etiology. An acute ulcer can be considered as a stage of gastric ulcer. In addition to H. pylori, perforation of the stomach can be provoked:
- Zolinger-Alison syndrome;
- drug ulcers and other endocrine diseases;
- pancreatogenic, hepatogenic and other types of acute ulcers (for example, Crohn's syndrome).
For the appearance of a hole in the gastric wall, its destruction in all layers of hydrochloric acid and an increase in pressure in the abdomen are of great importance. Performative chronic ulcer is considered the stage of progression of gastric ulcer. This pathology is formed during the absence of the necessary therapy.
Symptoms of the disease
Perforation of the wall of the stomach has 3 main stages:
- Shock state.
- False well-being.
- Peritonitis.
The shock stage itself occurs during perforation and the gastric contents fall on the peritoneum. A person feels an unbearable "dagger" pain that appears in the upper layers of the abdominal cavity, which quickly spreads to the entire area of the abdominal cavity. Most patients at this moment begin to rush and scream. The overall severity of the condition is rapidly increasing:
- pressure decreases;
- the pulse slows down;
- skin integuments become moist, cold and pale;
- the patient takes a forced position - on his side, with his knees brought up to his stomach.
After a certain period of time (approximately 7 hours) the pain subsides, and in some cases completely disappears. Slow bloating increases, it becomes not so tense, disappear with auscultation of noise in the intestine. Arterial hypotension persists, arrhythmia begins to appear and tachycardia builds up. The time of the stage of false well-being can reach up to 12 hours.
Possible consequences
During the previous two stages, a person gradually develops peritonitis. The degree of the condition is aggravated again: the patient is inhibited, the skin integuments become earthy, become sticky from sweat. The anterior wall of the peritoneum is tense. The volume of urine produced is significantly reduced, sometimes even reaching anuria.
If the patient has a peptic ulcer , the perforation is possible in the retroperitoneal tissue. In addition, the opening may be covered by food or surrounding organs. It is possible to limit the process in the presence of many adhesions. Covering perforation is of several types:
- permanent;
- long;
- short-term.
Such types of perforation are, as a rule, much easier. Cases of self-healing are known.
In addition to peritonitis, hypovolemia, shock and sepsis can complicate the passage of gastric disease.
Diagnosis of the disease "gastric ulcer"
Perforation of the stomach requires an accurate diagnosis, which can be established solely from a correctly collected medical history. To diagnose the disease, you must definitely consult a specialist. Gastroenterologists and endoscopists deal with such problems.
It is very important to be examined in a timely manner if you suspect that you have perforated stomach. The symptoms can in no way be ignored, since the advanced stage of the disease can lead to irreparable consequences. An appeal to an endoscopist and gastroenterologist is required for absolutely every patient with a suspicion of this disease, especially if there is a likely presence of closed perforation. However, studies do not show complete data for diagnosis, but their implementation is necessary as part of the preparation for a surgical operation.
Perforation of the stomach is determined in such ways:
- Survey radiography.
- Ultrasound of the abdomen.
- Esophagogastroduodenoscopy.
- With complications of establishing a diagnosis and suspicion of covered perforation, laparoscopy is used.
Diseases with similar symptoms
Perforation of the stomach can be attributed to such concepts as “acute abdomen”, therefore this disease must be differentiated from:
- pancreatitis
- cholecystitis and appendicitis;
- tumor decay;
- renal and hepatic colic;
- thrombosis of mesenteric veins;
- rupture of an aortic aneurysm in the abdominal cavity;
- heart attack;
- pleurisy.
Timely contacting a specialist and carrying out diagnostic measures will help to establish an accurate diagnosis and start treatment of a dangerous disease in time.
How to cure perforation?
Depending on the clinical picture, help with perforation of the stomach is several methods.
- Usual suturing ulcers. It is produced for young people without a history of ulcers, elderly patients with an increased risk of anesthetic and surgical care, as well as with existing diffuse peritonitis.
- If there is no peritonitis, this intervention can be supplemented with proximal selective vagotomy, which makes it possible to prevent prolonged treatment in the gastroenterology ward in the future.
- If there is an ulcer in the pyloric department, penetration of the ulcer, significant bleeding, stenosis of the output tract, as well as weakened people with a significant risk of surgery, the defect is excised, pyloroplasty, and stem vagotomy.
- When a patient has a mixed type of peptic ulcer or a history of additional gastric perforation is present, then this surgical operation can be supplemented with hemigastrectomy.
- Excellent results are available against the background of laparoscopic and endoscopic therapy. Endoscopic vagotomy and endoscopic treatment can complement the surgical intervention of perforation of the stomach.
If it is necessary to reduce the risk of surgical intervention, distal resection of the stomach or laparoscopic tamponade of perforation with the gland section is possible. These manipulations are best tolerated by patients, which can provide recovery in a much faster time.
After performing the surgery, an indispensable condition for the full correction of the patient is the cancellation of non-steroidal drugs (when their appointment allowed the appearance of a gastric ulcer) or their change to cyclooxygenase inhibitors, as well as conservative eradication.
Prevention and Prediction
During perforation, the prognosis is rather difficult, since untimely diagnosis of such a condition sometimes leads to the death of the patient. Among young men, the lethal outcome is about 2-6% (taking into account the clinical picture, time of care provided and some other factors), in elderly people this ratio increases several times.
Prevention of the disease is secondary - it is required to timely diagnose and treat those diseases that could bring the patient to this condition.