Ulcer penetration. Surgical treatment of an ulcer

Penetration is a common complication of peptic ulcer, which is often combined with stenosis, bleeding, or malignancy . Most often pierced the tongue of the posterior wall of the duodenum, the posterior wall and the lesser curvature of the stomach. Duodenal ulcers most often penetrate the head of the pancreas, which in turn can cause pancreatitis. In addition, often ulcers penetrate into the hepatoduodenal ligament. Sometimes a fistula forms with the common bile duct. In such cases, the disease can be complicated by cholangitis and hepatitis.

The pain syndrome is particularly persistent. Quite often pains lose periodicity and become constants. When the ulcer penetrates into the pancreas, patients usually complain of intense back pain.

For patients with penetrating ulcers without other complications (stenosis, bleeding, malignancy), it is advisable to conduct 1-2 courses of intensive conservative treatment in a therapeutic hospital.

If, after such treatment, healing of the ulcer is not observed, then the patient should undergo surgery. Particular care should be taken with penetrating gastric ulcers because of the danger of their malignancy.

Conservative treatment of peptic ulcer should begin in a hospital setting. It includes the appointment of an antiulcer diet, antacids and drugs that normalize gastric motility. With a duodenal ulcer, it is also advisable to use drugs that accelerate the regeneration processes. Treatment of gastric ulcers is carried out under mandatory X-ray and endoscopic control. Conservative treatment is described in detail in the course of internal diseases.

Surgical treatment of an ulcer

Indications for surgery are the most important in peptic ulcer surgery. Ball rooms, operated not according to strict indications, make up the main contingent of those suffering from diseases of the operated stomach and to a large extent discredit the method of surgical treatment. Surgical treatment is indicated mainly for complications of peptic ulcer. The most clear indications for it are formulated by V. “P. Berezov (1950), who divided them into three groups: absolute, conditionally absolute and relative. Absolute indications include: perforation of the ulcer, reasonable suspicion of the transition of the ulcer into cancer, stenosis and deformity ( Schmiden’s ) with impaired evacuation from the stomach.

Perforation of a stomach or duodenal ulcer is one of the most dangerous complications of peptic ulcer. Surgical treatment should be undertaken as early as possible, immediately after diagnosis.

Conservative treatment (Taylor, 1957), proposed for the treatment of perforations and consisting of active aspiration of gastric contents and massive antibiotic therapy, cannot be an alternative to the surgical method, because the mortality rate is incomparably greater. It can only be used involuntarily if, due to some conditions (the absence of a surgeon and the inability to deliver the patient to the hospital), it is impossible to perform the operation or it is necessary to gain time before the arrival of the surgeon. In any case, in a critical situation, this method should be remembered.

Reasonable suspicion of the transition of an ulcer into cancer . This complication refers to gastric ulcers, which, according to various statistics, in 15-20% of cases more often turn into cancer, while any convincing cases of malignancy of duodenal ulcers have not yet been described. Even the most modern examination, including gastroscopy with biopsy and cytological examination, does not always allow to establish the onset of cancerous degeneration of the ulcer. In order to avoid a fatal mistake, absolute indications should include not only those cases where the diagnosis of malignancy is established quite definitely, but also those when there is a reasonable suspicion that the ulcer has turned into cancer.

Organic stenoses of the outlet section of the stomach and duodenal bulb are subject to surgical treatment even in the stage of compensation, because all the experience of the development of surgery has proved that it is impossible to cure such patients with conservative measures and the longer this complication of peptic ulcer exists, the greater pathological changes occur in the body. Organic stenosis should be distinguished from functional stenosis arising from edema, an inflammatory reaction during an exacerbation of peptic ulcer. The latter can be relatively easily eliminated in the course of antiulcer therapy. The group of absolute indications also includes Schmiden’s deformities of the stomach, accompanied by impaired evacuation. The stomach is shaped like an hourglass or a snail. Such a deformation is either the result of a previous peptic ulcer, when the scars wrinkle and deform the stomach, or combined with an active ulcer. Conservative treatment of such patients is usually unsuccessful.

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