How is a perforated stomach ulcer manifested and treated?

A perforated stomach ulcer is a pathological condition accompanied by the formation of a through defect in the wall of the organ through which the contents of the stomach flow into the abdominal cavity. This complication of peptic ulcer disease, as a rule, occurs infrequently (no more than 2 cases per 10 thousand population). However, as statistics show, it is diagnosed in almost every tenth patient with a history of stomach ulcers. It is interesting that men are much more likely than women to face such a pathology. In this article, we will look at the main symptoms and treatments for perforated gastric ulcer.   

Symptoms of a perforated stomach ulcer

The main clinical manifestation of this pathological condition is sudden sharp pain in the abdomen. A sufficiently large number of patients indicate an increase in pain syndrome already several days before perforation. The pain can radiate to the right or left arm, depending on the localization of the ulcer.  

It is noteworthy that in the first few hours from the moment of perforation, soreness is determined mainly in the epigastric region. After some time, it becomes spilled.

Examination reveals tension in the anterior abdominal wall. Palpation of the abdomen is sharply painful. The patient is in a forced position with the knees brought to the abdomen. The clinical picture is complemented by a decrease in blood pressure, slowing heart rate, shortness of breath.

It is interesting that in old age, this pathology often has an erased course. In 2018, scientists from the Smolensk State Medical University published a paper on the results that it has been found that for elderly patients hospitalized over a perforated ulcer of the stomach, characterized by the presence of comorbidities, masking the symptoms of perforation.  

Tactics for the treatment of perforated gastric ulcer

The main method of treatment of perforated gastric ulcer is emergency surgery.

There are three possible approaches:

  • Closure of the perforated hole (with an asymptomatic course of the disease, the perforation is more than twelve hours old, the patient is in serious condition);
  • Excision of the ulcer (with bleeding, large opening, suspected malignant degeneration, and so on);  
  • Gastric resection (if the other two methods are not suitable).

In addition, in some cases, minimally invasive interventions are performed.

In the postoperative period, eradication therapy is prescribed, aimed at combating Helicobacter pylori infection, drugs that reduce gastric secretion.

In the event that medical assistance was not provided in a timely manner, the likelihood of death is extremely high. The prognosis significantly worsens when the patient is older than sixty-five years, the perforation is more than a day old, the presence of severe concomitant pathologies, as well as when the perforation is large.

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