Common complications of acute perforation of gastric ulcer

Acute perforation caused by gastric ulcer is a very serious complication caused by gastric ulcer. The phenomenon of patient death due to gastric ulcer perforation is also very common. It needs to be treated as soon as possible. There are two types of treatments for gastric ulcer: surgical and non-surgical. You should choose the appropriate method.

1. Symptoms and Signs

70% of cases of acute ulcer perforation have a history of ulcer, 15% may have no history of ulcer at all, and 15% of cases may have transient upper abdominal discomfort a few weeks before perforation. People with a history of ulcers often have a course of worsening general symptoms before perforation, but in a few cases it may occur during regular medical treatment or even during rest or sleep.

The typical symptom of DU perforation is sudden severe pain in the upper abdomen, which is knife-like and can radiate to the shoulder and quickly spread to the entire abdomen. Sometimes digestive juices can flow down the right paracolic gutter to the right lower abdomen, causing right lower abdominal pain. Patients often experience symptoms of shock such as pale complexion, cold sweat, cold limbs, and thin pulse, accompanied by nausea and vomiting. Patients often remember very clearly the exact time when the severe pain occurred. After 2 to 6 hours, a large amount of exudate in the abdominal cavity will dilute the digestive fluid, and the abdominal pain may be slightly relieved. Later, the symptoms gradually worsen as the disease progresses to the bacterial peritonitis stage.

Physical signs: The patient appears seriously ill, has a forced posture, and shallow breathing. There is tenderness and rebound pain in the entire abdomen, but it is most obvious in the upper abdomen, which presents a "board-like abdomen". After gastric perforation, air in the stomach can enter the abdominal cavity. When standing or semi-recumbent, the gas is located below the diaphragm, and the boundary of liver dullness on percussion shrinks or disappears, which is the so-called "pneumoperitoneum sign." If the amount of fluid in the peritoneal cavity exceeds 500 ml, a shifting dullness may be detected. Bowel sounds may disappear as soon as they begin to sound during auscultation, the so-called "silent abdomen". Usually high fever.

2. Medication

1. Non-surgical treatment

The main method is to reduce leakage through gastrointestinal decompression and control infection with antibiotics, waiting for the ulcer perforation to close on its own and the peritoneal exudate to be absorbed on its own. Non-surgical treatment has a high mortality rate, especially for older patients with ulcer perforation. If non-surgical treatment is delayed for too long, surgical treatment will increase the surgical mortality rate. After non-surgical treatment, half of the patients still have ulcer symptoms and eventually require surgery, and the re-perforation rate can be as high as 8.5%. In addition, there are a certain number of misdiagnoses and missed diagnoses. Therefore, strict indications should be followed when choosing non-surgical treatment:

① The perforation is small, the perforation occurs on an empty stomach, the amount of exudate is not much, and the symptoms are mild; ② The patient is young, the medical history is unknown, the diagnosis is uncertain, and the clinical manifestations are mild; ③ The patient cannot tolerate surgery or the conditions for surgery are not available; ④ The perforation time exceeds 24 to 72 hours, the clinical manifestations are not serious or have a localized trend (abscess may be formed). In short, perforation after a full meal, perforation of refractory ulcers, and pyloric obstruction accompanied by massive bleeding. Those with malignant transformation are not suitable for non-surgical treatment.

2. Surgery

At present, perforation repair and subtotal gastrectomy are mostly used in China. With the development of vagotomy, the surgical treatment of gastric ulcer perforation has also undergone new changes. In addition, a few hospitals have also carried out laparoscopic perforation repair or viscosuppression.