Among all chronic diseases of the organs located in the abdominal cavity, perforation of gastric and duodenal ulcers is approximately 2%. According to statistics, the frequency of such a 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 than in women.
Causes of perforation
Perforation of the stomach (perforation) appears with a decrease in nutrition of the bottom of the ulcer and the edges of the tissues. Occurs with various dysfunctions of the patency of blood vessels through the arteries. This explanation is proved by the fact that during perforation there is no bleeding at the site of the lesion of the duodenum or the wall of the stomach. Gastric ulcer perforation has 3 forms:
- typical (the contents of the stomach pour into the abdominal cavity, peritonitis develops);
- atypical (perforation is covered by food, omentum, mucosal folds, etc.);
- in the form of penetration (the bottom of the perforation opens into neighboringorgans).
As a rule, such a phenomenon is preceded by a strong pain syndrome characteristic of a peptic ulcer, which lasts for a long period. In this case, the collapse of the walls of its base is possible. Gastric perforation can be caused by:
- emotional and physical stress;
- drinking;
- exacerbation of peptic ulcer disease;
- overeating;
- injury;
- treatment with certain drugs that cause this pathology.
Note that older people may not have a history of ulcers, as these patients have a latent picture of the disease.
What causes perforation
Usually, acute ulcers are not associated with H. pylori infection in any way. Confirmation of peptic ulcer in 95% indicates its Helicobacter pylori etiology. An acute ulcer can be considered as a stage of gastric ulcer. In addition to H. pylori, gastric perforation can be provoked:
- Zolinger-Ellison 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 with hydrochloric acid and an increase in pressure in the abdomen are of great importance. Performative chronic ulcer is considered a stage in the progression of gastric ulcer. This pathology is formed during the absencenecessary therapy.
Symptoms of disease
Perforation of the stomach wall has 3 main stages:
- Shock.
- False prosperity.
- Peritonitis.
The immediate stage of shock occurs during perforation and entry of gastric contents onto the sheets of 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 abdominal cavity. Most patients at this point begin to thrash about and scream. The overall severity of the condition is rapidly increasing:
- pressure decreases;
- heart rate slows down;
- skin becomes wet, 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 weakens, and in some cases completely disappears. Slowly, bloating rises, it becomes not so tense, noises in the intestines disappear during auscultation. Arterial hypotension persists, arrhythmia begins to appear and tachycardia increases. 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 again aggravated: the patient is lethargic, the integuments of the skin acquire an earthy tint, become sticky fromsweat. The anterior wall of the peritoneum is tense. The volume of urine produced is significantly reduced, sometimes even reaching anuria.
If a patient has an atypical stomach ulcer, then perforation is possible in the retroperitoneal tissue. In addition, the hole may be covered by food or surrounding organs. It is possible to delimit the process in the presence of many adhesions. There are several types of perforation cover:
- permanent;
- long;
- 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 gastric disease.
Diagnosis of the disease "gastric ulcer"
Perforation of the stomach requires an accurate diagnosis, which can only be established by a properly collected anamnesis. To diagnose the disease, you must definitely contact a specialist. Gastroenterologists and endoscopists deal with such problems.
It is very important to be examined in a timely manner if there is a suspicion that you have a perforation of the stomach. In no case should symptoms be ignored, since an advanced stage of the disease can lead to irreparable consequences. Appeal to the endoscopist and gastroenterologist is required for absolutely every patient with suspicion of this disease, especially with the likely presence of a closed perforation. However, studies do not show complete data.for diagnosis, but they are needed as part of the preparation for surgery.
Perforation of the stomach is determined in the following ways:
- Plane X-ray.
- Ultrasound of the abdomen.
- Esophagogastroduodenoscopy.
- When the diagnosis is complicated and a covered perforation is suspected, laparoscopy is used.
Diseases with similar symptoms
Perforation of the stomach can be attributed to such concepts as "acute abdomen", because this disease must be differentiated from:
- pancreatitis;
- cholecystitis and appendicitis;
- tumor decay;
- renal and hepatic colic;
- mesenteric vein thrombosis;
- ruptured abdominal aortic aneurysm;
- 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 a perforation?
Depending on the clinical picture, gastric perforation can be treated in several ways.
- Usual ulcer closure. It is performed in young people without a history of ulcers, in older patients with an increased risk of anesthetic and operative care, and in those with diffuse peritonitis.
- If there is no peritonitis, this intervention can be supplemented with a proximalselective vagotomy, which makes it possible to prevent long-term treatment in the gastroenterology ward in the future.
- In the presence of an ulcer in the pyloric region, ulcer penetration, significant bleeding, stenosis of the outflow tract, as well as weakened people with a significant risk of surgery, excision of the defect, pyloroplasty and stem vagotomy are performed.
- When a patient has a mixed type of peptic ulcer or has a history of additional gastric perforation, this surgery may be complemented by a hemigastrectomy.
- Excellent results are available on the background of laparoscopic and endoscopic therapy. Endoscopic vagotomy and endoscopic treatment can complement gastric perforation surgery.
If it is necessary to reduce the risk of surgery, distal resection of the stomach or laparoscopic tamponade perforation of the omentum is possible. These manipulations are best tolerated by patients, which can provide a much faster recovery.
After performing a surgical operation, an indispensable condition for the complete recovery of the patient is the abolition of non-steroidal drugs (when their prescription allowed the appearance of a gastric ulcer) or their change to cyclooxygenase inhibitors, as well as conservative eradication.
Prevention and forecasting
During perforation, the prognosis is quite difficult, since late diagnosis of such a condition sometimes leads to the death of the patient. Lethal among youthsthe outcome is about 2-6% (taking into account the clinical picture, the time of assistance provided and some other factors), in the elderly 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 state.
