The danger of perforated stomach ulcers, treatment. The main symptoms of perforation of a stomach ulcer

Perforated gastric ulcer is one of the most dangerous complications peptic ulcer. With this pathology, a rupture of the stomach wall occurs at the site of an acute or chronic ulcer. In this case, gastric contents freely enter the abdominal cavity and retroperitoneal space.

IN in rare cases perforation of the ulcer is accompanied by bleeding. The incidence of pathology in the presence of a stomach ulcer reaches 20%. In men, perforated ulcers develop 10–20 times more often than in women. Symptoms perforated ulcer stomach are described below.

The disease is typical for patients with latent gastric ulcer. It may not be diagnosed, but when questioning the patient, complaints of pain typical of peptic ulcer are revealed. In 25% of people, perforation of an ulcer is the first symptom of its presence; this is observed in the case of “silent” juvenile ulcers.

Provoking factors are:

dietary violations: alcohol intake, food containing large number spices, overeating, food with high content plant fibers;
intense physical activity that causes sudden tension in the abdominal muscles, such as lifting weights.

Prevention of pathology is timely and full treatment Peptic ulcer, compliance with the doctor’s recommendations on nutrition and diet.

Stages of disease development

Some patients experience prodromal symptoms (previous signs) of the disease: a slight increase in pain, low-grade fever. The duration of these symptoms is 1–2 days. Their low specificity and weak severity are mistaken by patients for exacerbation of gastritis or ulcerative gastric ulcer. There are three stages in the development of a perforated gastric ulcer:

Primary shock stage

The patient feels a sharp, unbearable pain in the epigastric region (above the navel), radiating to left shoulder and a spatula. Often patients describe it as “dagger-like”, “as if hit with a knife”, “a blow of a whip”.

With a perforated gastric ulcer, a characteristic position of the patient is observed: lying on his back or on his side with his legs pressed to his stomach. Movement in this pose abdominal wall minimal, which reduces the intensity of pain. The person experiences severe weakness, even to the point of fainting. Characterized by pallor of the skin (up to a grayish tint, the so-called ashen pallor), cold sticky sweat. The duration of this stage is 6–10 hours.

Upon examination, the doctor will find:

Stage of false (clinical) remission

The person feels a decrease in the intensity of pain. Appears extreme thirst. Fever 37.3–37.5 0C. The moisture and pallor of the skin disappear, they become dry and hot. These symptoms develop over 6–12 hours. It is during this period that an error in setting is most likely correct diagnosis. Often a perforated ulcer is mistaken for acute appendicitis or an attack of cholecystitis.

During the examination, the doctor will note the following signs:

swollen, tense stomach that does not participate in the act of breathing;
there is no intestinal peristalsis, the so-called “deafening silence” symptom;
low blood pressure;
rapid heartbeat (tachycardia);
positive signs of peritoneal irritation.

Stage of peritonitis

With further progression of the process, peritonitis develops - a common inflammation of the peritoneum. The patient complains of renewed pain, which takes on a burning character. Their intensity increases to an unbearable level. Uncontrollable vomiting appears, which does not bring relief. Body temperature rises. The patient develops a characteristic facial expression, the so-called Hippocratic mask - pale, with sunken eyes and cheeks. The patient's condition quickly becomes critical.

Signs of perforation of a stomach ulcer

The classic form of the disease is characterized by a stable triad of symptoms. The main symptoms of perforation of a stomach ulcer:

The characteristic position of a patient with a perforated gastric ulcer is lying down, with his legs pressed to his stomach;
acute “dagger” pain that occurs suddenly;
tense abdominal muscles, “board-shaped” stomach.

In obese patients with weakened muscle tone, muscle tension may not be observed. For elderly patients with reduced reactivity of the body, erased symptoms without pronounced symptoms are characteristic. pain syndrome and symptoms of peritoneal irritation.

An atypical picture is also observed with the so-called covered perforation. This form of the disease develops when adhesions form around the ulcerative opening, which delimit the perforation area from the rest abdominal cavity. As a result, only a local inflammatory reaction develops. In this case, the initial symptoms ( sharp pain, abdominal wall tension) disappear after a few hours. Only local pain remains at the location of the ulcer. Subsequently, a limited abdominal abscess develops.

Perforated ulcer of the stomach and twelve duodenum- one of the most severe diseases of the abdominal cavity. Perforation is serious complication stomach ulcer and duodenum occurs frequently, ranking second after acute appendicitis.

As with others acute diseases abdominal cavity, with a perforated ulcer, early referral, timely diagnosis and surgical intervention are a condition for a favorable outcome.

Despite all the achievements of recent decades in the treatment of peptic ulcers, the incidence of perforated ulcers reaches 10%. They account for up to a quarter of all complications of peptic ulcer disease and symptomatic ulcers. It is more often observed in men. Moreover, this dangerous condition can end not only in surgery, but also in death.

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. Perforation is essentially the appearance of a through hole in the wall of the stomach and the flow of stomach contents into the abdominal cavity of the patient and its parts.

This phenomenon is very dangerous in itself; a fairly large number of deaths occur in cases where the diagnosis of the disease was carried out too late, or in the case when the patient ignored simple rules treatment and recovery after surgery.

Perforation of the organ wall certain factors contribute:

lack of treatment for exacerbation of ulcers;
gross dietary violations;
severe overeating;
frequent stressful situations, constant mental and mental stress;
heavy physical activity and increased pressure inside the abdominal cavity;
long-term use of glucocorticosteroids and salicylic acid preparations.

As you can see, the causes of this disease can be easily prevented if you are careful about your health.

Symptoms of a perforated stomach ulcer

In the case of a perforated ulcer, the severity of symptoms directly depends on clinical form perforation. It could be:

typical, when the contents of the stomach immediately flow into the abdominal cavity (up to 80 - 95%);
atypical (covered perforation), if the resulting hole is covered by the omentum or other nearby organ (about 5 - 9%).

The classic picture of signs of a perforated ulcer is observed when there is perforation into the free abdominal cavity, which occurs in 90% of cases. It distinguishes 3 periods:

primary “abdominal shock” (chemical inflammation);
latent period (bacterial);
spilled purulent peritonitis.

Harbingers of perforation may be:

increased pain in the patient;
chills;
nausea;
“unreasonable” vomiting;
dry mouth.

Then there is a sudden change in the picture of the disease. The patient develops:

intense burning pain, which is usually compared to a blow from a dagger;
weakness;
increased, then decreased heart rate;
a drop in blood pressure with loss of consciousness and sometimes even with the development of a state of shock.

Pain shock stage

During this period, the patient feels acute pain in the abdomen. Patients compare it to the blow of a dagger: it is a sharp, severe and acute pain. At this time, vomiting may occur, the patient has difficulty getting up, his skin is pale and may protrude. cold sweat.

Breathing is rapid and shallow, pain occurs when taking a deep breath, blood pressure is low, but the pulse remains within the normal range: 73-80 beats per minute. With a perforated duodenal ulcer, the abdominal muscles are tense, so palpation is difficult.

Hidden period

The duration of the second period is usually 6–12 hours. Symptoms include the following:

the face acquires a normal color;
pulse, blood pressure and temperature return to normal;
shallow breathing, dryness and coated tongue are absent;
painful sensations subside (as the contents of the stomach flow through the right lateral canal, the pain remains, but becomes less intense and becomes localized).

As a rule, it is during this period that patients are confident that the disease has subsided and are reluctant to allow themselves to be examined and hesitate before agreeing to surgery.

Peritonitis

The transition of the disease to the stage of diffuse peritonitis occurs by the end of the first day. The pain returns in an even more pronounced form and becomes unbearable. The patient suffers from nausea and vomiting. Sometimes hiccups come along. Body temperature increases to 38 degrees C.

The abdomen becomes distended, and when listening to bowel sounds with a stethoscope, very faint sounds are noted, but sometimes only silence can be heard.

Diagnostics

The diagnosis of a perforated gastric ulcer is based on a detailed questioning of the patient and examination. Since in some cases the patient sees a doctor in the second period of the disease, when symptoms are not expressed, a mistake may be made.

Therefore, if there is any suspicion of perforation, it is necessary to conduct a comprehensive examination:

X-ray diagnostics. With its help, you can determine the air in the abdominal cavity (in 80% of cases). In this case, it is necessary to characteristic features(“subphrenic crescent”), differentiate from signs of airy intestines.
Endoscopy. Used when negative results X-ray examinations, but if a perforation is suspected. Allows you to determine the presence of a peptic ulcer and the localization of the lesion. The study is carried out using air pumping, which helps determine the true clinical picture.
Diagnostic laparoscopy is the most sensitive method detection of perforated gastric ulcer, gas and effusion in the free abdominal cavity.

IN clinical analysis blood there will be all signs of inflammation ( increase in ESR, the level of band leukocytes), and during bleeding the hemoglobin level will decrease.

Perforated stomach ulcer: surgery

Treatment of a perforated gastric ulcer is only surgical, and the operation must be carried out as quickly as possible. early dates, because in the third period of the disease it may no longer be meaningful.

The general choice of operating allowance depends on:

Time elapsed from the onset of the disease.
Properties of the ulcer (origin, localization).
The severity of the phenomena of peritonitis and its prevalence.
The age of the patient and whether he has severe concomitant pathology.
Technical capabilities of the hospital and skills of the medical team.

Surgery for a perforated gastric ulcer in most cases is carried out through classical laparotomy (dissection of the anterior abdominal wall). This is determined by the need to conduct a thorough examination of the abdominal organs. Sometimes it is possible to suturing small perforations using the laparoscopy method (through a puncture of the abdominal wall).

Diet

After surgery for a perforated ulcer, the diet is based on limited consumption salts, liquids and simple carbohydrates(sugar, chocolate, baked goods, etc.). On the 2nd day after surgery they give mineral water, weak tea and fruit jelly with a little sugar.

10 days after the operation, the patient begins to be given mashed potatoes, as well as boiled pumpkin and carrots. All food should be soft, not spicy, not salty, not fatty. Bread is allowed to be added to the menu only after a month.

Basic principles diets:

The daily number of meals is up to 6 times, in small portions.
All foods taken must be puree or semi-liquid.
Food should be steamed or boiled
Salt should be taken in limited quantities
You should also limit your intake of simple carbohydrates (sugar, chocolate, baked goods) and liquids.

In general, after surgery for a perforated ulcer, you must follow a special diet for 3 to 6 months.

Forecast

Absence surgical treatment leads to death within the next week after perforation, in almost all cases. With surgical treatment, the average postoperative mortality is 5-8% of various complications associated with the general severity of the condition, age and concomitant pathology of the patient.

According to statistics, the earlier the operation was performed, the lower the risk fatal outcome. For example, when performing an operation in the first 6 hours, the risk is up to 4%, after 12 hours - 20%, after 24 hours - 40% and higher.

Perforated, or perforated, ulcer of the stomach and duodenum is a severe and very dangerous disease. For short term(several hours) a person develops purulent inflammation abdominal cavity. If emergency medical care is not provided to the patient, the disease ends in death.

Description of the disease

A perforated ulcer is a through hole formed in the walls of the digestive organs as a result of recurrent inflammation. In this case, inside the organ, there may be profuse bleeding. But the main danger is that, with this pathology, the contents of the stomach or intestines enter the abdominal cavity.

As a result of bacterial and chemical exposure toxic substances purulent inflammation (peritonitis) begins in the peritoneum. Due to the fact that inflammatory process develops at lightning speed, in the absence of emergency care, the consequences will be tragic.

Perforation of a stomach ulcer is not an independent disease. It appears against the background of an existing peptic ulcer of the stomach and duodenum. If a peptic ulcer is not treated for a long time, hydrochloric acid can corrode (perforate) the mucous layer digestive organ until a through hole is formed.

This defect can occur not only in the stomach, but also in the intestines and on the walls of the esophagus. However, in the vast majority of cases, perforation occurs in the lower part of the stomach or in the duodenal bulb, which is adjacent to it. The size of the perforated hole can reach 10 cm in diameter.

Perforation of gastric and duodenal ulcers affects about 10% of patients diagnosed with peptic ulcer disease digestive tract, which is quite a high figure.

Due to the rapid spread of infection in the abdominal cavity, the mortality rate for perforated ulcers is very high.

With urgent first aid and quick surgical intervention, this figure does not exceed 18%. If more than 12 hours pass from the onset of symptoms to surgery, the mortality rate is about 70%. At the same time favorable outcome Treatment is mainly given to patients under 50 years of age.

This disease affects all categories of the population, including children, but in women it occurs several times less often than in men.

The highest incidence rate occurs in men aged 20-50 years. In young men, gastric perforation may appear suddenly. At the same time, a person could previously feel healthy.

Causes of the disease

Perforation in the walls of the digestive organs appears in both the stomach and duodenum. It is initiated by a large amount of hydrochloric acid produced by the stomach to digest food. Modern medicine believes that main reason The cause of peptic ulcers is the bacterium Helicobacter pylori. However, for its activation in the body, provoking factors are necessary. These include:

violations in immune system body;
long-term use of antibacterial drugs that greatly affect the microflora of the digestive tract;
nervous disorders, strong psycho-emotional stress;
frequent smoking. At the same time, they decrease protective functions body, there is an imbalance in the functioning of the mucous layer;
chronic alcoholism. The mucous membrane is damaged as a result of constant exposure to alcohol-containing drinks;
poor nutrition. Abuse of fatty and junk food, which negatively affects the mucous membrane. Eating very hot or cold food, which damages the walls of the digestive organ. Prolonged fasting or excessive intake of large amounts of food, which stretches the walls of the stomach;
genetic factor. Hereditary predisposition to such diseases;
severe physical exertion, abdominal injuries.

Types of ulcers

Perforation of a stomach ulcer may cause different character and vary in location, nature of occurrence and clinical manifestations. The course of the disease can occur in different ways, depending on a number of factors.

In some cases, the ulcer may be covered by another organ located nearby, then a covered perforation occurs. In view of this circumstance, the entry of intestinal contents into the peritoneum may stop. Then, the pain is erased, purulent inflammation is localized in the subhepatic region or iliac fossa.

If, over time, the perforation opens again into the abdominal cavity, the initial symptoms appear and the inflammation progresses. Another option is possible, in which an abscess develops at the site of initial localization. Extremely rarely, a situation arises in which a covered ulcer heals and a scar appears in its place.

In the atypical form, the perforation may open into the omentum located behind the stomach or into the intercommissural space. In these cases, it can be very difficult to make a diagnosis, since the clinical manifestations are quite atypical. Due to the penetration of perforation into the tissue of the omentum, purulent inflammation begins there.

With him long stay, the abscess grows, which leads to erosion of the walls of the stomach. With this development of the situation, perforation of the stomach wall into the peritoneum and fulminant peritonitis occurs. As a result, toxic shock occurs.

According to the stages of development of purulent inflammation, perforation of gastric and duodenal ulcers differs into the following phases:

stage of primary shock (development of chemical peritonitis);
spread of bacteria, followed by inflammatory reaction(false positive period);
extensive purulent-inflammatory process in severe form.

Symptoms of the disease

A perforated gastric ulcer has symptoms that clearly indicate the presence of this disease. Symptoms vary depending on the phases of development of the abscess. The first signs of a perforated ulcer begin to appear from the moment the contents of the digestive tract penetrate into the peritoneum.

The first stage lasts about six hours and is characterized by the occurrence of sharp acute pain in the upper abdomen. Then, pain spreads throughout the entire abdominal area and can radiate to the shoulder and shoulder blade area on the right.

The pain is so severe that the person lies bent over without changing position. The face turns pale and cold sweat appears. In this case, a decrease in heart rate may be observed. The abdominal muscles are very tense and do not take part in the breathing process.

Next, the second stage begins, which takes from 6 to 12 hours and is characterized by imaginary well-being. External signs(pulse, breathing, etc.) are brought back to normal, the pallor of the skin is eliminated. At the same time it appears white coating on the tongue.

The pain gradually disappears, but upon palpation the pain is still present. The abdominal muscles relax somewhat. Pain may appear in the lower abdomen, on the right, due to the flow there purulent discharge. Intestinal peristalsis fades, which is associated with paralysis of the intestinal muscles.

A doctor examining a patient at this stage may make an erroneous conclusion and diagnose appendicitis. The patient, feeling the subsidence of symptoms, may refuse hospitalization. In this phase of the development of inflammation, it is necessary to make a reliable diagnosis, since delay can cost a person his life.

In the third phase of the disease, which begins 12 hours after the opening of the ulcer, sharp deterioration condition. Severe, frequently repeated vomiting begins. The patient experiences an increase in temperature, increased heart rate, and decreased blood pressure.

Dry skin and mucous membranes are observed. Tongue covered brown coating. Swelling appears in the abdomen, and upon palpation the presence of fluid is felt. Urgent surgery is largely useless at this stage.

Diagnosis of the disease

Diagnosis of perforated gastric and duodenal ulcers is performed using laboratory tests. First, the doctor conducts a general examination, with palpation and identification of complaints. An x-ray may be prescribed to detect air in the peritoneal area.

The patient donates blood for general and biochemical analysis. This allows you to determine the presence of inflammation in the body and the degree of intoxication.

It allows you to verify the presence of an ulcer endoscopic examination which is carried out using a probe inserted into the patient's stomach. In this case, the location of the perforation and its size are determined. If diagnosis is difficult, straightening the stomach walls with air is used.

To detect malfunctions cardiovascular system, an electrocardiogram is prescribed. It's playing important role when planning an operation. A study such as ultrasound makes it possible to see an abscess hidden in the intercommissural space. It also shows the presence of fluid in the abdominal space.

Treatment of perforation

Treatment of a perforated ulcer involves surgical intervention. If the patient refuses the operation, death occurs.

For perforated gastric ulcer, operations can be divided into two main types:

with preservation of organs - suturing of a perforated ulcer;
with partial removal of stomach tissue (ulcer excision).

The choice of technique depends on several factors. These include:

the patient's age and condition;
origin and localization of perforation;
extent of abscess spread;
time of peritonitis.

Suturing of a perforated ulcer is performed under general anesthesia. It is shown when severe conditions, with the development of extensive peritonitis. This technique is used in elderly patients with high operational risk. It is also carried out in young people, with acute forms peptic ulcer, without pronounced chronic symptoms.

Suturing is performed when purulent inflammation is observed for more than six hours. This operation may have complications. The postoperative period requires a long drug therapy.

Excision is prescribed to the patient if he has an old large ulcer that cannot be sutured. It is carried out in cases where there are two or more through holes, as well as if the perforation is caused by a tumor. Excision is prescribed when peritonitis develops in less than 12 hours.

In this case, part of the patient's stomach is removed. The patient is assigned a disability group. After surgery, treatment with antibacterial drugs is indicated. Complications after operations occur in rare cases. This is mainly a bleeding defect in the gastrointestinal tract or the formation of local abscesses. There may also be rupture of the sutures with penetration of intestinal contents into the peritoneum.

In the postoperative period, in addition to drug therapy, the patient is prescribed a strict diet. During the first two days, only drinking water is allowed. Then, you can take liquid food: pureed soups, porridge with water, jelly. After ten days, foods such as boiled vegetables, fermented milk products, lean meat and fish are gradually introduced into the diet.

After returning to a normal diet, you should adhere to the principles healthy eating. You should eat healthy natural products, such as fruits and vegetables, dairy products, lean meat of dietary varieties. It is necessary to minimize the intake of fried, spicy and salty foods, marinades and smoked foods. Drinking alcohol and smoking are completely prohibited.

At the first sign of a perforated ulcer, seek immediate medical attention. qualified help. If you have gastritis, do not delay its treatment to avoid the development of more serious diseases.

It is extremely important to know the symptoms of a perforated stomach ulcer because... this disease poses a direct threat to the patient’s life. Recognizing symptoms early and seeking medical help can save the life of you or your loved ones. What this disease is and how it progresses clinical picture, read further in the article.

General understanding of a perforated ulcer

Everyone knows about peptic ulcers to one degree or another. But what is a perforated gastric and duodenal ulcer? How can this condition be determined, and by what manifestations?

A perforated ulcer, also called a perforated gastric ulcer, is a complication of peptic ulcer disease, an urgent condition, part of a group of diseases united under the name “ acute stomach» and requiring immediate medical care. Perforation of a stomach ulcer occurs in the case of an untreated inflammatory-ulcerative process, when the ulceration becomes deep, penetrating through the entire gastric wall. The same mechanism of perforation of a duodenal ulcer.

As a result of the fact that in the wall of the stomach (or small intestine) a breakthrough has formed, the contents of the stomach or duodenum enter the abdominal cavity, causing inflammation in it - peritonitis. This condition is extremely life-threatening and requires immediate surgical intervention.

Today, medical statistics register up to 3 million cases of duodenal and gastric ulcers in our country alone. Most often, middle-aged men suffer from the disease, however, almost anyone can get sick.

Perforated gastric ulcer and perforated duodenal ulcer occur in 3% of patients suffering from chronic peptic ulcer disease. A perforated gastric ulcer, like a perforated duodenal ulcer, can be provoked by the following factors:

increased gastric acidity due to consumption of foods not included in the diet (for example, alcohol or spicy foods);

simultaneous intake of large amounts of food;

inflammations that occur, in addition to the main focus, on the mucous membrane.

Thus, a perforated ulcer of the stomach and duodenum is a consequence of an advanced, untreated peptic ulcer. Its occurrence can be prevented by controlling the course of the disease and following a diet.

Causes of stomach ulcers

The main cause of inflammation of the gastric mucosa (as well as the small intestine) is called Helicobacter, the consequences of which are gastritis and peptic ulcers. More than half of all people living on the globe are carriers of the bacterium, but in in good condition The pathogen does not manifest itself in any way. Doctors identify several factors that can cause the onset of peptic ulcers:

decreased immunity due to various reasons– suffered stress, infectious disease, therapy with immunosuppressive drugs;
irregular sleep patterns, incl. night work;
uncontrolled use of non-steroidal anti-inflammatory drugs, long-term treatment hormonal drugs(Cortisol, Polcortolone, Dexamethasone);
smoking and alcohol abuse;
poor quality food, irregular diet, spicy, fatty or salty foods;
hereditary predisposition;
the presence of other gastrointestinal diseases.

Read also Symptoms and treatment methods for rotavirus infection

Classification of perforated ulcers

Most often, ulcer perforation is noted in the area of the anterior wall of the prepyloric section of the stomach and the duodenal section - the duodenal bulb.

There are three various shapes perforated ulcer:

Typical - the contents of the stomach enter the free abdominal cavity.
Atypical - the contents of the stomach enter the omentum or omental bursa, in some cases - into the intercommissural area or retroperitoneal tissue.
Perforation with bleeding - in addition to the contents of the stomach, a large amount of blood enters the abdominal cavity.

In most cases, with any of these forms of the disease, there are several stages of its course:

Stage of primary chemical peritonitis (pain shock).
Stage bacterial peritonitis(imaginary well-being).
The stage of severe disease (the occurrence of purulent peritonitis).

If the disease is detected in a timely manner, if first aid was provided and immediate treatment of the perforated ulcer began, the disease does not go away listed stages, stopping at the stage of perforation itself and not developing into bacterial or purulent peritonitis. The earlier the disease is detected, the greater the patient’s chances for a successful recovery and a full, productive life.

Symptoms of a perforated ulcer

Symptoms of a perforated gastric or duodenal ulcer vary depending on the periods of development of the disease described above.

During the period of chemical peritonitis of the stomach or duodenum, the symptoms are: extreme pain in the upper abdomen, then gradually spread to the entire area of the abdomen, localizing mainly in the area of the navel and left hypochondrium. The abdomen is tense and “board-shaped.” The patient takes a forced position, lying on his back or right side, with his knees tucked under him. The first signs of a perforated ulcer last from 3 to 6 hours. Most often the patient is called ambulance, because The pain is very intense and unbearable.

After this, a period of bacterial peritonitis begins, when the patient experiences imaginary relief. The pain subsides, tense muscles relax, the patient calms down, unfortunately, loses control over his condition. Meanwhile, the intoxication of the body intensifies, the body temperature rises, the patient’s tongue is dry, covered gray coating. An operation to eliminate a perforated gastric ulcer is often not performed precisely because of the imaginary relief during this period, when the patient refuses help and hospitalization.

A perforated gastric ulcer is a serious complication of peptic ulcer disease, characterized by perforation of the stomach wall, the development of bacterial peritonitis and, if not treated in a timely manner, ends in death in 100% of cases.

What is the mechanism of development of an ulcer and its perforation?

Main etiological factor development of ulcers of the gastric mucosa - Helicobacter pylori. Under action acidic environment(gastric glands produce excess hydrochloric acid) there is an active proliferation of microbes that corrode the mucous and muscular lining of the stomach, forming a defect - an ulcer. If left untreated, the wound does not heal, increases in size, and spreads not only to the mucous membrane, but also to other layers of the organ. After reaching the outer layer of the stomach, a through hole is formed - perforation. Through which undigested food remains from gastric juice enter freely into the abdominal cavity, omental bursae, then causing peritonitis (inflammation of the peritoneum).

Factors that provoke the development of a peptic ulcer and its complications

The mechanisms of perforation and development of stomach ulcers are completely different. Most people suffer from uncomplicated peptic ulcers, and only 20% of patients have high risk complicate the ulcer by perforation. Therefore, to avoid the development of a seemingly harmless, uncomplicated ulcer, it is necessary to know what factors can provoke it:

Causal factors for perforated gastric ulcers

A prerequisite for the development of perforation is the presence of a chronic or acute ulcerative defect in the gastric region. But, as mentioned above, this complication develops in people who:

More and more common every year atypical forms stomach ulcers that are asymptomatic. Therefore, healthy people with a genetic predisposition need to do it once every 2 years (if chronic gastritis– once a year) undergo FEGDS (fibroesophagogastroduodenoscopy).

Interesting to know! Just a few decades ago, Japan ranked first in the world in terms of the prevalence of gastric and duodenal ulcers among the population. In order to improve the quality of health and life, the government of the country included FEGDS in the annual mandatory range of studies. Therefore on at the moment, the incidence and incidence of peptic ulcer disease in Japan have decreased several times.

Symptoms of perforation of a peptic ulcer

In the normal course of the disease, 3 stages are distinguished, which have significant differences in the clinical picture.

Stage 1

Stage 1 – period of abdominal shock. Duration – 6 hours. This stage characterized by the occurrence of sudden severe pain like a “dagger strike” in the gastric region (epigastric), possibly localized near the navel or in the right hypochondrium near the liver. In rare cases, a single vomiting is possible at the beginning of the disease. Due to severe pain, the patient brings his knees to his stomach and tries not to move. His face takes on a pained look, skin pale with a bluish tint, damp, cold.

The patient begins to breathe shallowly and frequently, since every small movement in amplitude chest causes unbearable pain. At the beginning of the disease, the heart rate corresponds to normal numbers or decreases slightly, and blood pressure drops rapidly.

It is important to note that the higher the heart rate and lower the blood pressure, the worse prognosis sick. These indicators indicate not only perforation of the ulcerative defect, but also stomach bleeding, the so-called “mirror ulcer”.

In the stage of abdominal shock, you can determine:

sharp pain in the abdomen in the epigastric region, several hours after the onset of the disease, the pain becomes diffuse;
tension in the muscles of the abdominal wall - the stomach is like a “board”;
bloating and flatulence;
rectal – pain occurs when high blood pressure on the wall.

Stage 2

Stage 2 is a period of imaginary well-being. Duration about 5-6 hours. The patient’s well-being improves, abdominal pain and abdominal muscle tension decrease. But symptoms of peritonitis begin to develop. On initial stage It is quite difficult to understand what a terrible complication of peptic ulcer disease one had to deal with, so it is necessary to pay attention to the presence of the following symptoms: euphoria, increased heart rate, dry skin and tongue, increased body temperature, increasing bloating, long absence acts of defecation.

Stage 3

Stage 3 – the period of diffuse bacterial peritonitis. It occurs 11-12 hours after the ulcer perforates. Accompanied by chills, an increase in body temperature to 40-41, rapid pulse, low blood pressure, sallow skin color, depression eyeballs and sharpening of facial features (the face of Hippocrates).

With diffuse peritonitis, active proliferation of pathogenic bacteria occurs, which rapidly spread throughout circulatory system to target organs:

It is obvious that the period of diffuse bacterial peritonitis is accompanied by “fading” protective forces body. Therefore, if assistance is not provided in a timely manner, the chances of recovery are reduced to zero.

How to correctly diagnose a perforated gastric ulcer?

First you need to rely on specific clinical manifestations patient: previously diagnosed chronic gastric ulcer; sudden dagger pain in the epigastric zone or near the navel, which subsequently becomes diffuse; tension in the muscles of the abdominal wall, the stomach does not participate in the act of breathing - “board-shaped stomach”; The characteristic position of the patient in bed is lying down, with the legs brought to the stomach.

It is not possible to make a diagnosis based solely on the symptoms seen, so it is necessary to carry out a certain number of additional studies:

General principles of treatment of perforated gastric ulcer

The main condition for successful treatment is to immediately organize hospitalization in surgical hospital, since the ulcer will not heal on its own.

At the initial stage, if there are signs of diffuse peritonitis, infusions should be prescribed vasoconstrictor drugs and inhale oxygen.
Perforated stomach ulcer - absolute reading to surgical treatment. But, as you know, patients in absolutely all situations have the right to refuse; in this case, a conservative therapy– treatment of perforated gastric ulcer using the Taylor method.
What is it and what complications can it lead to?

In the beginning gastric tract the patient is locally anesthetized with a solution of tetracaine, after which a thick probe is inserted into its cavity, which releases the stomach from the contents. Next, the probe is removed, replaced with a nasogastric (inserted through the nasal passages) thin probe, and connected to two-day aspiration. At the same time, an ice pack is applied to the stomach (to stop bleeding), the water-salt balance is adjusted, parenteral nutrition and detoxification are prescribed. Prevent the development of septic processes by prescribing antibacterial drugs lasting 7-10 days.

After the complex therapeutic measures, medical workers check the effectiveness of the prescribed therapy - a water-soluble solution is passed through the nasogastric tube contrast agent, and with the help of radiography they are convinced of the closure of the ulcerative perforated defect.

It would seem that the treatment of a perforated gastric ulcer is quite simple and low-traumatic, but the Taylor method in most cases is complicated by the formation of local abscesses in the abdominal cavity, which subsequently leads to purulent peritonitis and sepsis. Therefore, sooner or later you will have to resort to full-fledged surgical treatment, the question is different - will it be relevant?

IN surgical treatment There are 3 main methods for treating a perforated ulcer: closing the perforated defect, excision of a perforated gastric ulcer, and gastric resection.
Closing the ulcer is possible with the help of tamponade, covering it with an omentum, and suturing.
Indications for this operation: disease duration of more than 12 hours, asymptomatic perforation of the ulcer, third stage of disease development (purulent peritonitis), elderly and old age(high degree of operational risk), “young” ulcers (in young people without signs of chronic ulcerative defect).

If during laparotomy it is discovered: 2-3 degree gastric stenosis, bleeding, callous edges of the ulcer, large sizes perforation and suspicion of malignant degeneration of the ulcerative defect - it is necessary to excise the perforated ulcer.

Gastric resection is the most traumatic operation, which involves removing the segment of the stomach affected by the ulcer. Performed strictly according to indications: ulcer with callous edges, penetrating ulcer, multiple gastric ulcers, malignancy of gastric ulcer, if it is impossible to carry out eradication therapy in postoperative period, the size of the perforated ulcer is more than 2 cm.

Today, the laparoscopic surgical technique has reached its maximum popularity. It has a number of advantages over laparotomy:

low tissue trauma,
short recovery period,
reduced risk of surgical wound infection,
the ability to conduct a high-quality examination of the abdominal organs,
absence of postoperative scars,
reduction in the incidence of death in the postoperative period.

In the treatment of perforated gastric ulcers with an uncomplicated course, preference is given to laparoscopy. Therefore, there is no need to worry too much and replay bloody scenes in your head, since the operation is carried out in the most gentle way possible.

The operation is completed. What to do next?

In the early postoperative period, patients with a perforated gastric ulcer are recommended to active image life: perform breathing and therapeutic exercises, switch to full-fledged balanced diet. Following these instructions makes it possible to prevent the development of complications and speed up the process of restoration of the gastric mucosa.

As for diet, failure to follow it can reduce the healing process to zero. The essence of the diet is to intensify work gastrointestinal tract and its restoration.

What is the diet after gastric surgery?

During the first days, patients should refuse normal nutrition and give preference to parenteral nutrition. Next, gradually switch to non-rough liquid food: soups with vegetable broth, ground porridge, unsweetened tea or compote. Food portions should be small, but meals should be frequent. This will allow the stomach not to experience “extra stress”.

It is necessary to give up cigarettes, alcohol, carbonated drinks, sweet, sour, spicy, very hot and cold foods forever. You should give preference to dishes slightly warmer than the room temperature. For the first 4-5 weeks after surgery, you should not eat bread at all. If you have heaviness in the stomach and possible indigestion, you can “help” it by taking Mezim or Festal.

Regarding drug therapy, then after surgical treatment, to avoid complications and relapses, patients are prescribed antacids, M-anticholinergics, antibacterial agents aimed at destroying Helicobacter.
A perforated stomach ulcer is the most dangerous complication Peptic ulcer, which is quite easy to treat if the patient consults a doctor in a timely manner and the diagnosis is immediately verified. Therefore, in order to avoid unpleasant consequences, you need to remember that the ulcer itself will not heal, it only needs to be treated and the sooner the better.