A perforated ulcer of the stomach and duodenum is one of the hardest diseases of the abdominal cavity. Perforation is a serious complication of gastric ulcer and duodenal ulcer occurs frequently, taking second place after acute appendicitis.
As with other acute diseases of the abdominal cavity, with a perforated ulcer, early treatment, timely diagnosis and surgical intervention are the precondition for a favorable outcome.
Despite all the achievements of the last decades in the treatment of peptic ulcer, the frequency of perforated ulcers reaches 10%. They account for up to a quarter of all complications of peptic ulcer and symptomatic ulcers. More often it is observed in men. And the terrible condition can end not only with the operation, but also with a fatal outcome.
Causes
Why does a perforated stomach ulcer develop, and what is it? A perforated ulcer is not an independent disease, but a complication of a stomach ulcer. The perforation is essentially the appearance of a through hole in the wall of the stomach and the flow of the contents of the stomach into the abdominal cavity of the patient and its part.
This phenomenon is very dangerous in itself, there is a sufficiently large number of deaths in those cases when the diagnosis of the disease was carried out too late, or in the case when the patient ignored the simple rules of treatment and recovery after surgery.
Body wall perforationcertain factors contribute:
- no treatment for ulcer exacerbation;
- gross violations of diet;
- severe overeating;
- frequent stressful situations, constant mental and mental stress;
- heavy physical exertion and increased pressure inside the abdominal cavity;
- long-term use of glucocorticosteroids and preparations of salicylic acid.
As you can see, the causes of the development of this disease can be easily prevented if you take good care of your health.
Symptoms of a perforated stomach ulcer
In the case of perforated ulcers, the severity of the symptoms directly depends on the clinical shape of the perforation. She may be:
- typical, when the contents of the stomach immediately flows into the abdominal cavity (up to 80 - 95%);
- atypical (covered perforation) if the resulting hole is covered by an omentum or other nearby organ (of the order of 5-9%).
The classical picture of signs of a perforated ulcer is observed during perforation into the free abdominal cavity, which occurs in 90% of cases. It distinguishes three periods:
- primary "abdominal shock" (chemical inflammation);
- the latent period (bacterial);
- diffuse purulent peritonitis.
The precursors of perforation can be:
- increasing the patient's pain;
- chills;
- nausea;
- "Causeless" vomiting;
- dry mouth.
Then there is a sudden change in the picture of the disease. The patient appears:
- intense burning pain, which is usually compared with a dagger blow;
- weakness;
- Increase, then decrease in heart rate;
- a drop in blood pressure with loss of consciousness and sometimes even with the development of a shock state.
Stage of pain shock
During this period the patient feels a sharp pain in the abdominal region. Patients compare it to a dagger blow: it is a sharp, severe and sharp pain. At this time, vomiting may occur, the patient is difficult to get up, his skin is pale and cold sweat may appear.
Breathing is rapid and superficial, with deep inspiration, pain arises, blood pressure is lowered, but the pulse remains within the limits of the norm: 73-80 beats per minute. With the perforated ulcer of the duodenum, the abdominal muscles are strained, so the feeling is difficult.
Hidden period
The duration of the second period, as a rule, is 6-12 hours. Among the symptoms are the following:
- the face acquires a normal color;
- pulse, pressure and temperature return to normal;
- superficial breathing, dryness and lagging of the tongue are absent;
- the pain subsides (when the contents of the stomach flow along the right lateral canal, the pain remains, but becomes less intense and acquires a localized character).
As a rule, it is during this period that patients are sure that the disease has receded, and they are reluctant to allow themselves to be examined, lingering before agreeing to an operative intervention.
Peritonitis
The transition of the disease to the stage of diffuse peritonitis occurs at the end of the first day. Painful sensations return in an even more pronounced form, become intolerable. The patient is tormented by nausea, vomiting. Sometimes hiccups join. Body temperature increases to 38 degrees Celsius.
The abdomen becomes swollen, when hearing intestinal noises with a stethoscope very weak noises are noted, but sometimes one can hear only silence.
Diagnostics
The diagnosis of perforated gastric ulcer is based on a detailed inquiry of the patient and examination. Since in some cases the patient gets to the doctor in the second period of the disease, when the symptoms are not expressed, an error may be committed.
Therefore, for any suspicion of perforation, a comprehensive examination is necessary:
- X-ray diagnostics. With its help, you can determine air in the abdominal cavity (in 80% of cases). It is necessary at the same time, according to the characteristic features ("sub-diaphragmatic semilunity"), differentiate from the signs of the intruded intestine.
- Endoscopy. It is used for negative results of X-ray studies, but if suspected of perforation. It allows to determine the presence of peptic ulcer, localization of the focus. The study is conducted with the help of air pumping, which helps to determine the true clinical picture.
- Diagnostic laparoscopyis the most sensitive method of detecting a perforated ulcer of the stomach, gas and effusion in the free abdominal cavity.
In the clinical analysis of the blood there will be all signs of inflammation (an increase in ESR, a level of stab wedges), and with hemorrhage the hemoglobin level will decrease.
Perforated stomach ulcer: operation
Treatment of perforated stomach ulcers is only surgical, and the operation should be performed as soon as possible, because in the third period of the disease it may already be meaningless.
The overall choice of operational benefit depends on:
- The time that has elapsed since the onset of the disease.
- Properties of ulcers (origin, localization).
- The severity of the phenomena of peritonitis and its prevalence.
- The age of the patient and the presence of severe concomitant pathology.
- Technical capabilities of the hospital and the skills of the medical team.
Operation with the perforated ulcer of the stomach in most cases is carried out by means of classical laparotomy (dissection of the anterior abdominal wall). This is determined by the need for a thorough audit of the abdominal cavity. Sometimes it is possible to sew small perforations by applying laparoscopy (through a puncture of the abdominal wall).
Diet
After the operation with a perforated ulcer the diet is based on a limited consumption of salt, liquid and simple carbohydrates (sugar, chocolate, pastries, etc.). On the second day after surgery, they give mineral water, soft tea and fruit jelly with a small amount of sugar.
10 days after the operation, the patient is given a mashed potatoes, as well as a boiled pumpkin and carrots. All food should be soft, not spicy, not salty, not greasy. Bread is allowed to be added to the menu only after a month.
Basic principlesdiet:
- Daily amount of food intake up to 6 times, in small portions.
- All products should be pure, semi-liquid.
- Cooking should be steamed or boiled
- Salt should be taken in limited quantities
- Also, you should limit the intake of simple carbohydrates (sugar, chocolate, pastries) and liquids.
In general, after the operation with a perforated ulcer, it is necessary to observe a special diet for 3-6 months.
Forecast
The absence of surgical treatment leads to death within the next week after perforation, in almost all cases. In surgical treatment, the average postoperative lethality is 5-8% of various complications associated with the total severity of the condition, age and concomitant pathology of the patient.
According to statistics, the earlier the operation was performed, the less the risk of a lethal outcome. For example, during an operation in the first 6 hours the risk is up to 4%, after 12 hours - 20%, after 24 hours - 40% and higher.
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