Penetration of gastric ulcers is rare. Penetration of gastric and duodenal ulcers. What it is

Experts call diseases of the stomach the most common pathologies. One of the most serious diseases is a stomach ulcer, the consequences of which many patients often do not think about. It begins with a banal gastritis, which later turns into an erosive, and then into an ulcerative lesion of the mucous membrane. Often, such damage penetrates beyond the inner part of the stomach, deepening into the muscular wall of the organ. A similar process can end with perforation or penetration. These complications of stomach ulcers are considered life-threatening for the patient.

One of the serious complications of a stomach ulcer is its spread to neighboring organs.

One of the severe complications of gastric ulcer is the penetration of an ulcer into organs adjacent to the stomach. In medicine, this phenomenon is called a penetrating ulcer (from the Latin penetracio - penetration). A similar pathology is diagnosed mainly with damage to the posterior wall of the stomach.

The essence of the complication is the deepening of the ulcer into the thickness of the muscle fibers and passing through them, followed by a deepening in the tissues located in the immediate vicinity of the focus of the organs. Most often, the penetrating form of the ulcer affects the following organs:

small omentum;
pancreas (its capitate part);
peritoneal ligament (hepatoduodenal);
mesentery of the colon;
transverse part of the colon;
gallbladder;
liver.

The ulcer may have spread to the capitate of the pancreas

In some cases, when timely treatment is not carried out, the formation of communicating anastomoses - fistulas, through which the contents can penetrate from one organ to another. At this stage, the complication may end in sepsis or profuse internal bleeding.

Causes of penetration

The occurrence of ulcer penetration is primarily due to the presence of a destructive process. However, the following conditions are necessary for its distribution:

deepening of the ulcer in the deep submucosal and muscular layers of the stomach;
small diameter of the ulcer (with a large focus, the probability of penetration is always lower, such cases usually end with perforation and extensive internal bleeding);
adhesive process, in which the internal organs are in contact with each other.

The mechanism for the development of penetration consists in the destruction of the outer walls of the stomach, as a result of which the contents of the organ begin to penetrate into the abdominal cavity in small quantities. This leads to an inflammatory process, the result of which is the formation of adhesions between adjacent organs. The contents of the stomach stop flowing into the abdominal cavity, and begin to act more locally, literally corroding the outer shell of the contact organ.

Penetration of the ulcer may occur if the formation is small

Since the organs have the ability to regenerate, the penetration of a stomach ulcer is accompanied by the formation of connective (scar) tissue around the lesion. As a result of this process, a fistula canal is formed, the walls of which are practically not affected by gastric juice. At the same time, there is a more active deepening of the ulcer in the affected organ. Pronounced sclerotic processes occur in it, and the stomach acquires an atypical shape (remains curved).

Symptomatic picture of ulcer penetration

Like other complications of gastric ulcer, penetration is accompanied by typical symptoms. First of all, the patient begins to worry about pain, which is not associated with food intake or time of day (peptic ulcer, on the contrary, has a clear link to these factors). The nature and localization of this symptom depends on which organ the ulcer has penetrated:

When the lesser omentum is affected, the pain spreads to the right side of the abdomen, usually at the top. Often, pain radiates to the shoulder and subclavian region on the right.

Localization of pain depends on the area of damage to the organ

When the mesentery of the colon and the intestines are affected, the pain spreads to the central part of the abdomen, and is especially felt in the navel. Additional symptoms are fecal vomiting and defecation of food unchanged.
When the gallbladder is affected, the pain is localized in the epigastrium on the right with irradiation to the subscapular region. An additional symptom with this type of lesion is bitter belching and vomiting mixed with bile.
When the retroperitoneum is affected, there are signs of sepsis with symptoms typical of general intoxication of the body and high body temperature.
With liver damage, the patient has icterus of the sclera, an increase in body temperature. Pathology in its course resembles hepatitis.

At any localization of penetration, the patient has pain, which gradually weakens as the fistula canal forms. Also, the body temperature periodically rises to 37-37.5 degrees.

Sometimes there is an increase in temperature during penetration

Diagnosis of complications

Such consequences of an ulcer as penetration require a detailed diagnosis. To begin with, the gastroenterologist collects an anamnesis, from which it is possible to understand how and when the nature of the pain changed (there was no longer any discomfort associated with food intake), as well as the presence of a diagnosed stomach ulcer. After that, the patient is assigned a number of instrumental and laboratory studies:

a complete and general clinical blood test for neutrophilic leukocytosis;
fibrogastroduodenoscopy for changes in the shape of the ulcer crater, its depth and shape (during the examination, tissues can be taken for analysis - a biopsy);
radiography of the abdominal organs for localization and depth of the ulcerative focus, the presence of contact between organs and limitation of their mobility;
ultrasound examination of the abdominal organs for changes in the state of their membrane and parenchyma.

Ultrasound of the peritoneum is performed to diagnose the consequences of ulcer penetration.

The last method of examination gastroenterologists usually choose laparoscopic examination. In the course of its use, it is possible to visually assess the condition of the external walls of the stomach and organs into which the ulcer has penetrated.

Treatment methods for penetrating ulcers

There are not many methods for the treatment of a penetrating ulcer. The peculiarity of the complication is that drug treatment, even if the disease is at the first stage of development, does not have the expected effect. If we talk about neglected conditions, when a fistula has already formed, one cannot do without surgical intervention.

The most effective method of eliminating penetration is considered to be gastric resection, during which a part of the organ damaged by the pathology is removed. At the first stage of the disease, when there is no fistula, and the inflammatory infiltrate is observed in a limited area of \u200b\u200bthe organs, vagotomy is practiced - the intersection of the vagus nerve in order to reduce the synthesis of hydrochloric acid. However, such manipulations are used only to stop the progression of the complication, but do not solve the problem of already existing damage.

Often it is not possible to cope with pathology without resection

The banal division of organs united by a fistula is rarely practiced due to the high risk of their damage and extensive necrosis.

With timely detection of pathology, the prognosis is favorable. However, the patient will have to take medicines for a long time, the action of which is aimed at restoring the functions of damaged organs. In the absence of therapy, the risk of complications such as bleeding and resulting shock remains very high.

In the video below we will talk about stomach ulcers:

Penetration of a stomach ulcer is the process of penetration of a pathological formation into nearby organs. As a result of this, the fibrous tissues fuse and the two organs are connected.

In the initial stages, it leads to constant pain and a deterioration in the general well-being of a person. If left untreated, very serious, life-threatening complications are possible.

The reasons

Penetrating ulcers of the stomach and duodenum appear as severe. The main causes of the development of pathology are directly related to the presence of progressive ulcers on the gastric mucosa.

The deeper the layers of the walls of the digestive organ are affected, the higher the risks of penetration of the ulcerative formation into the organ adjacent to the stomach. Ulcer penetration occurs more often if there are adhesions between individual organs in the upper abdomen.

As a rule, a penetrating ulcer on the wall of the stomach or duodenum is small - up to one and a half centimeters. Pathology always occurs against the background of an inflammatory process, which can be caused by various factors, for example:

Diet failure.
Stress and nervous strain.
Bad habits.
Uncontrolled intake of drugs.

Symptoms

Penetration of gastric and duodenal ulcers can manifest itself with various symptoms, depending on the severity of the complication and the organ that is involved in the pathological process.

Most often, ulcers penetrate the pancreas. In this case, acute pain occurs, which can cause shock. Other symptoms overlap with those of acute pancreatitis:

There are jumps in blood pressure.
or constipation.

When a penetrating ulcer involves the intestines, severe pain can occur in the umbilical region. This often occurs:

Vomiting with bile.
Heaviness in the abdomen.
Heartburn and belching.
False urge to defecate on the background of constipation.

When a penetrating ulcer of the bile ducts is affected, a sharp increase in temperature is always observed and severe pain occurs in the region of the right hypochondrium. In addition, there are all signs of intoxication. Over time, yellowness of the skin appears, and in severe cases, loss of consciousness occurs.

Penetration of ulcer formation into the liver is accompanied by pronounced weakness and. At the same time, pains that begin in the right hypochondrium quickly spread to the entire abdomen. There are also signs of inflammation of the liver: jaundice occurs and dark urine is observed.

stages

At the first stage of the development of the pathology, a slight ulceration occurs that affects the walls of a nearby organ, and an adhesion is formed. Against the background of a prolonged inflammatory process, there is an increasing fusion of the tissues of the two organs, and this indicates that the disease has passed into the second stage.

Further, if measures are not taken or when treatment does not give a positive result, tissue destruction begins and ulceration affects another organ. At the third stage of the disease of the stomach, penetration occurs.

Deformation of the tissues of another organ and their destruction indicates the fourth stage of the development of the disease. This period is associated with, as well as with the appearance of other symptoms, indicating the development of a serious complication.

It is very difficult to stop the inflammatory process during ulcer penetration. The contents of the stomach begin to penetrate into the neighboring organ and cause swelling of the tissues and their further destruction.

Diagnostics

Diagnosis of developing complications associated with ulcer penetration is sometimes difficult due to the fact that the symptoms coincide with those of many other diseases. Because of this, only a comprehensive examination of the patient can clarify the clinical picture.

First, when confirming the presence of a peptic ulcer, the doctor must examine the patient and collect an anamnesis of the disease. He clarifies in which areas and when pain sensations arose, as well as where the pain radiates. The following laboratory tests and hardware studies are used to make a diagnosis:

General blood analysis. In it, the ESR indicator is very important, which, when increased, indicates the development of inflammation.
Fibrogastroduodenoscopy. In this way, you can examine the existing ulcer and determine the depth of its crater.

X-ray. It allows you to detect an increase in the depth of the ulcer and fix the restriction of its mobility.
Laparoscopy. With the help of this study, it is possible to visualize the bonds of the ulcer formation with another organ.
Ultrasound allows you to examine all the organs of the abdominal cavity for changes in their structure due to penetration of the ulcer.

Treatment

Penetrating ulcers are difficult to treat conservatively. It is possible to slow down the progression of the pathological process by conservative methods only at the initial stage of development. are carried out exclusively in a hospital, since gastroenterologists must monitor the patient's condition around the clock.

Necessarily with the conservative treatment of a penetrating ulcer is necessary. Its purpose is to reduce the load on the gastrointestinal tract. The diet includes only light food, which should be consumed often, but in small portions.

Advice! During the treatment of a penetrating ulcer, bad habits should be abandoned.

When the condition worsens or when the disease has reached the third stage, a complex operation is performed. Sometimes surgical treatment involves resection of 2/3 of the stomach and part of the organ where the ulcer has penetrated.

Medical preparations

Conservative methods of treatment can be used only if there is no deformation of the organ that is affected by the inflammatory process. Drug therapy involves taking the following drugs:

Drugs that stimulate gastric motility.
Antacids that reduce acidity.
Medicines that promote tissue regeneration.

Taking medications in the early stages can slow down the progression of the disease. With good immunity, subject to all medical recommendations, tissue scarring may begin. But at the same time, the process of treatment with conservative methods is always very long.

Folk remedies

Folk remedies after confirming the diagnosis of a penetrating ulcer cannot become the main therapeutic agents. They can only be used as an additional method of treatment.

Many have a healing effect. Therefore, their use in the treatment of peptic ulcer is fully justified. There are a lot of folk recipes, the effectiveness of which has been confirmed by time. But it should be remembered that before you start using such funds, you must always consult a doctor.

Forecast

If a penetrating ulcer was diagnosed at stages 1-2 of development, the prognosis is almost always favorable. With the help of conservative methods of treatment and adherence to a strict diet, it is usually possible to stop the pathological process. But it should be understood that it will take a long time to heal an ulcerative lesion.

When diagnosing a disease of 3-4 degrees, a positive prognosis is only possible. At the same time, it is very important that appropriate rehabilitation is carried out after the operation. For a long time, you need to be very careful about your health so that complications do not arise, in particular, stomach cancer.

Penetrating gastric ulcer is a very serious disease, but it can be overcome with the right attitude. In addition to observing all medical prescriptions, it is necessary to give up bad habits, avoid stress and lead a proper lifestyle, in which there must be a place for good rest.

It may develop in the form of complications. Ulcer penetration is one of the options for the consequences of the ulcer process.

Description of the disease

Violation of the integrity of the wall of the duodenum or stomach opens the beginning of the formation of an ulcer. If the ulcer continues to deepen and captures the destruction of more and more new layers of the organ wall, then in the future the continuation of the situation may be:

- this is the opening of the ulcer into the cavity
or penetration - the opening of an ulcer into a nearby organ.

The situation when an ulcer in its development penetrates into the body of an organ that is in the neighborhood occurs due to the tendency of the human body to adhesive processes. This phenomenon enables closer and more fixed contact of the organ affected by the ulcer with the adjacent organ.

An ulcer in the main organ develops inside the wall due to the inflammatory process that accompanies this phenomenon. When the ulcer becomes penetrating, the inflammatory process is projected onto the wall of the adjacent organ at the point where the ulcer exits the tissues of the main organ.

Usually the development of such a mechanism is the exit of an ulcer into another organ, possibly with a small area of the ulcer of the main organ. If the diameter of the ulcer is more than 1.5 cm, then the amount of gastric juice escaping through it does not contribute to the gradual creation of an ulcer of the neighboring organ. In this case, perforation of the ulcer occurs, which is often accompanied by shock.

A stomach ulcer can penetrate:

into the small omentum
or into the pancreas.

A duodenal ulcer can penetrate into such organs:

large intestine
pancreas,
liver,
bile ducts.

The reasons

The possibility of developing an ulcerative process in the main organ in the direction of transferring the problem to a neighboring organ appears as a result of the influence of such factors:

The presence of an ulcer in the duodenum or in the wall of the stomach.
The area of the ulcer is small - the diameter is within 1.5 cm.
The patient's body has a tendency to adhesive processes.

stages

The appearance of a penetrating ulcer goes through three stages:

The ulcer is located in the duodenum or stomach and is in the period of spreading deep into the wall of the organ.
Between the organ with an ulcer and the neighboring organ, their mutual proximity is fixed through the adhesive process.
The spread of the inflammatory process to the projection of the future ulcer on the body of a neighboring organ with the development of the ulcer itself in its wall.

Symptoms of penetration of gastric and duodenal ulcers

When an ulcer enters another adjacent organ, the following symptoms appear:

some painful symptoms are observed that are characteristic of the case in which the organ the ulcerative process enters:
- the ulcer penetrates into the lesser omentum - pain radiates to the collarbone or to the right shoulder;
- in the pancreas - often there is pain in the back, it can be felt in the lower back: give to one of the sides or be encircling;
- in the area of the large intestine - irradiation of painful symptoms occurs in the navel area;
- with penetration of ulcers located in the upper part of the stomach, pain can be projected onto the region of the heart;
the organs where the ulcer has penetrated signal the appearance of symptoms characteristic of their defeat:
- when the ulcer penetrates into the liver, symptoms of acute hepatitis appear,
- the same in the intestines - signs of colitis or duodenitis,
- the same in the biliary tract - symptoms of acute cholangitis,
- the same in the pancreas - signs of acute pancreatitis;
common symptoms appear:
- pain that used to appear in the epigastric region in connection with food intake or had its own daily rhythm, changed its character and became constant and intense in strength;
- there is an increase in temperature for no apparent reason,
- abdominal muscles are in tension,
- the analysis of peripheral blood changes - indicates the presence of an inflammatory process.

Diagnostics

The disease does not manifest itself very clearly, the symptoms are similar to many other diseases, so the diagnosis is complex.

Mandatory diagnostic measures include the following actions:

The specialist makes an anamnesis of the patient according to his complaints and observations.
The clinical manifestations of the disease are examined, information is analyzed about the areas in which the pain irradiates.
The examination includes the delivery of clinical tests to patients.
X-ray of the stomach is performed.
A mandatory measure for establishing an accurate diagnosis is fibrogastroscopy.

Treatment of gastric ulcer penetration

Ulcers, the condition of which is within the limits of the first and second stages, are subject to conservative treatment. The course is conducted in a hospital setting.

The patient is prescribed:

drugs that normalize gastric motility;
antacids,
a diet aimed at the disappearance of provocations for ulcerative processes,
in some cases, regenerating drugs are recommended.

Due to the fact that a penetrating ulcer poses a danger to human health, the results of treatment are monitored using x-ray equipment.

Penetrating ulcers that have already reached the third stage in their pathological development are recommended to be treated surgically. The same appointment is given to patients with ulcers of the initial stages, if conservative methods do not bring the expected positive result.

The following types of operations are used:

vagotomy,
resection,
draining operation.

Forecast

In the early stages of the disease, the body can be maintained within normal limits with timely treatment and diet. At later stages, surgical intervention and careful attention to one's health are required in order to prevent complications.

The negative consequences include the following:

ulcer perforation,

With timely treatment, 99 out of 100 patients are cured and lead a normal life.

If you do not seek medical help or allow the development of complications, then the prognosis is unfavorable.

Penetration of an ulcer is the penetration of an ulcerative lesion into neighboring organs. There is penetration of gastric and duodenal ulcers. Erosions are localized mainly in the head of the pancreas, large channels of the gallbladder, liver, hepatogastric ligament, and large intestine.

What is a disease

In simple words, a penetrating gastric ulcer is the spread of the inflammatory process to other organs, followed by the formation of erosions.

Stages of penetration:

the spread of erosion throughout all layers of the walls of the stomach, duodenum 12;
connective tissue fusion with nearby organs or organ;
penetration of erosion into the tissues of organs.

The first stage is characterized by the progression of chronic inflammation in erosion with partial destruction of the walls of the stomach or duodenum. The second stage is characterized by deep destruction of the walls of the affected organs.

At the third stage, the complete destruction of all layers of the walls of the organ or organs occurs. In doing so, they undergo deformation.

Reasons for development

The main causes of the development of pathology are the presence of progressive ulcers and a penetrating inflammatory process. That is, if gastritis, gastroduodenitis is not cured in time, then the walls of the stomach or duodenum become covered with sores. In the future, they appear in neighboring organs.

The key role in this is played by the increased production of hydrochloric acid, which is part of the gastric juice. Factors such as malnutrition, infection, non-compliance with the rules of treatment provoke excessive production of hydrochloric acid.

Acting regularly on the ulcer, the acid causes more and more inflammation. As a result, the layers of the walls of the stomach and duodenum 12 will be affected deeper and deeper. The result is penetration.

Forecast

If there is no adequate treatment, the prognosis is poor. During the formation of ulcers, normal healthy tissues are replaced by adhesions. This process causes deformation of the organs, which can cause narrowing of the gaps, obstruction of food.

These complications of ulcerative lesions lead to the development of shock, often causing death. If timely surgical intervention is performed, then the prognosis is positive. Healing occurs in 99%.

Symptoms of pathology

Symptoms of penetration depend on the stage of pathology. If the disease has just begun to progress, then the person will feel symptoms characteristic of peptic ulcer: pain in the stomach, navel (but the hallmark of this pathology is that the pain is regular, regardless of eating). Hungry pains during penetration bother a person less often. In the future, with the defeat of any organ, the disease manifests itself in different ways.

If an ulcer has penetrated into the pancreas (head region), then signs of acute pancreatitis appear:

the pain is very intense, cutting, dull (can cause pain shock) - the main symptom;
heat;
increase or decrease in blood pressure;
hiccups, nausea, belching, vomiting (with bile);
diarrhea or constipation;
dyspnea;
cyanosis of the skin.

With the defeat of the bile ducts, the following symptoms appear:

a sharp rise in body temperature to 38-40 ° C;
severe sweating, drowsiness;
intense pain in the right hypochondrium, similar to biliary colic;
intoxication, expressed by weakness, loss of appetite, headache, nausea, vomiting, diarrhea;
yellowness of the skin;
impaired consciousness (in severe pathology);

Penetration into the intestinal area is manifested by symptoms of duodenitis, colitis:

a feeling of fullness in the abdomen;
lack of appetite;
heartburn;
belching;
nausea, vomiting with bile;
false urge to defecate;
heaviness in the abdomen;
constipation.

If penetration occurs in the liver, then this condition is characterized by an attack of acute hepatitis:

nausea;
weakness;
pain in the right hypochondrium, spreading throughout the abdomen;
jaundice;
dark urine;
skin itching;
enlargement of the liver in size;
weakness, headache.

When penetrating in the peritoneum appears:

heat;
weakness, thirst;
abdominal pain - severe, paroxysmal;
lumbar edema.

Diagnosis and treatment

Diagnosis of penetration includes examination of the patient, identification of symptoms, laboratory and instrumental examination.

For the establishment of an accurate diagnostician is assigned:

delivery of tests;
fibrogastroduodenoscopy procedure;
fluoroscopy technique;
laparoscopic examination;
ultrasound examination.

Treatment of this pathology is best done surgically. No medicines, dietary supplements and other drugs will help prevent irreversible consequences. Moreover, the earlier the pathology is diagnosed, the more successful the treatment.

Do not forget that any ulcer can cause sepsis, peritonitis after perforation.

At the first stages of the lesion, doctors can still prescribe a course of complex therapy, if healthy tissues are not replaced by connective tissue and organ deformation has not occurred. Medications are also prescribed if the penetration of the ulcer did not lead to stenosis, bleeding and other complications.

A drug course of therapy is carried out only in a hospital, since the patient and his standing should be monitored around the clock. When the condition worsens, cardinal methods of treatment are immediately taken. At advanced stages, an operation is performed, in some cases, resection, vagotomy.

Carrying out the treatment of peptic ulcer on your own is at least not stupid. If you experience the above symptoms, you should immediately call an ambulance or go to the hospital. Penetration is a rather serious complication that can cause irreversible consequences.

ICD-10

K25 K26

General information

Ulcer penetration is one of the frequent consequences of peptic ulcer, detected in 30-40% of patients with a complicated course of the disease. It is 13 times more common in men. More than 2/3 of the patients are people of working age. Up to 90% of penetrating ulcers are localized in the piloantral part of the stomach and the initial sections of the duodenum. Penetration into the pancreas is observed in 67.8% of patients, into the liver, lesser omentum and hepatoduodenal ligament - in 30.3% (with approximately the same distribution between organs). In 1.9% of patients, the ulcer grows into the intestine, mesentery, and gallbladder. In 25-30% of cases, germination is combined with bleeding, in 30% - with stenosis and perforation.

The reasons

Penetration of gastroduodenal ulcers into other organs of the abdominal cavity contributes to the long course of peptic ulcer, resistant to treatment. There are a number of anatomical, topographic and clinical preconditions that increase the likelihood of this pathology. According to experts in the field of clinical gastroenterology, the reasons for the formation of a penetrating ulcer can be:

Fixed position of the adjacent organ. With a snug fit of the gastric or duodenal wall to the parenchymal or hollow organ, the interorgan ligament creates conditions for the formation of peritoneal adhesions. That is why ulcers of the posterior wall of the stomach and duodenum more often penetrate, which is less displaced during breathing and filling with chyme.
The ineffectiveness of the treatment. The progression of the disease with germination in the surrounding organs may be due to the wrong choice of medical tactics, the irregularity of taking the prescribed drugs, the refusal of surgical treatment in case of drug resistance of the condition. In patients with Helicobacteriosis, ulcer penetration is promoted by immunodeficiency.

Pathogenesis

The mechanism of the development of the disease is represented by three successive stages of morphological changes. At the first stage of ulcer penetration under the influence of aggressive gastrointestinal factors, the ulcerative-destructive process extends not only to the mucous membrane, but also to the muscular and serous layers of the gastric or duodenal wall. Further, in the projection of the ulcerative defect, fibrous adhesions are formed between the stomach or duodenum and an adjacent organ. At the stage of completed perforation, ulcerative destruction of the tissues of the underlying organ occurs.

Gastric ulcers often grow into the body of the pancreatic gland and the lesser omentum. It is extremely rare that an ulcerative defect of the greater curvature of the stomach penetrates into the anterior wall of the abdomen with the formation of an infiltrate that simulates gastric cancer. Penetration of duodenal ulcers usually occurs in the liver, bile ducts, head of the pancreas, transverse colon, its mesentery, ligaments connecting the liver with the duodenum, stomach. The pathogenesis of the disorders is based on the development of periulcerous inflammation and digestion of the tissues of the involved organ.

Symptoms of ulcer penetration

The clinical picture depends on the duration of the disease and the organ into which germination occurred. The main symptom of ulcer penetration is a change in the nature and daily rhythm of pain. The pain syndrome intensifies, ceases to be associated with the diet. Localization of pain sensations varies depending on the organ involved in the process. When penetrating into the tissue of the pancreas, the pain is girdle, radiating to the back and spine; when the omentum is damaged, the greatest intensity of pain is noted in the region of the right hypochondrium.

A characteristic sign of penetration is the lack of effect from antispasmodics and antacids, with which patients try to reduce pain. Nonspecific dyspeptic symptoms may occur: nausea, vomiting, disturbances in the frequency and nature of the stool. In most cases, there is a deterioration in the general condition: an increase in body temperature to subfebrile figures, a decrease in working capacity, a deterioration in appetite up to a complete refusal of food.

Complications

The germination of the ulcer is accompanied by the ingress of aggressive or infected contents into the involved organs, which in 50% of cases leads to their inflammation. When the gallbladder is damaged, acute cholecystitis can occur, which is manifested by repeated vomiting with bile, intense pain in the right hypochondrium, icteric staining of the skin and sclera. When the ulcer penetrates into the parenchyma of the pancreas, the exocrine function of the organ decreases, and the digestion of food is disturbed. Patients develop steatorrhea, tentorrhea, and weight loss.

In rare cases, penetration is complicated by perivisceritis. In immunocompromised patients, the disease can lead to a generalization of the inflammatory process, the entry of toxins and pathogenic microorganisms from the digestive system into the bloodstream, which is accompanied by the development of sepsis. With penetration, combined with perforation, diffuse or limited peritonitis occurs due to the entry of intestinal or gastric contents into the free abdominal cavity. The predominant forms of liver damage are infiltrative hepatitis and fatty degeneration.

Diagnostics

Diagnosis can be difficult because perforation and other complications are difficult to distinguish from ulcer penetration during the peak period. It is possible to suspect the disease if local pain and infiltration in the abdominal cavity are detected. Diagnostic search is aimed at a comprehensive laboratory and instrumental examination of the patient. The most informative are:

Microscopic analysis of feces. The coprogram is used for differential diagnosis with other pathologies of the digestive system. To exclude bleeding from an ulcer, the Gregersen reaction to occult blood is prescribed. If pancreatitis is suspected, stools are additionally examined for the level of fecal elastase.
Endoscopic methods. EGDS is an informative method that is used to visualize the mucous membrane of the initial sections of the gastrointestinal tract. In case of penetration, a deep rounded niche with clear contours is revealed, the tissue around the ulcer has no signs of infiltration. Additionally, an endoscopic biopsy is performed.
X-ray examination. Performing x-rays after oral administration of contrast allows you to visualize the main signs of penetration. Characteristic is the leakage of the contrast agent outside the organ, the appearance of a three-layer shadow on radiographs, deformation of the contours of the stomach and duodenum 12.
Histological analysis. Cytomorphological examination of tissue taken from the pathologically altered stomach wall is carried out to exclude malignant neoplasms. In peptic ulcer disease, biopsy specimens show inflammatory infiltration, while cells of a normal structure, without pathological mitoses.

In the general blood test during penetration, leukocytosis, an increase in the ESR value are determined. In the biochemical analysis, hypoproteinemia, hypergammaglobulinemia, an increase in the concentration of acute phase indicators can be detected. For an express assessment of the state of the digestive tract, ultrasound is performed - a non-invasive method that allows you to exclude or confirm the involvement of other organs in the process.

Germination of the ulcer, first of all, must be differentiated from acute pancreatitis. The main diagnostic criteria for penetration are a long ulcerative history in the patient, the absence of ultrasound signs of pancreatic destruction. They also carry out differential diagnosis with cancer-gastric ulcer - in this case, the correct diagnosis is helped by the data of histological analysis of biopsy specimens. In addition to a gastroenterologist, a surgeon and an oncologist are involved in examining a patient with penetration.

Treatment of ulcer penetration

Effective conservative methods of treatment of penetrating gastric and duodenal ulcers have not been proposed. The appointment of antisecretory, enveloping and antibacterial drugs provides a temporary effect, but does not stop the progression of penetration. Surgical treatment, as a rule, is carried out in a planned manner. When penetration is combined with other complications of peptic ulcer (bleeding, perforation), the operation is performed urgently. The volume of surgical intervention depends on the location of the ulcer, the size and other features of the ulcer:

With penetration of a gastric ulcer: usually a distal resection of the stomach is performed with the removal of 1/2 or 2/3 and antiseptic treatment or tamponing of the damaged area of the adjacent organ with an omentum. At 1-2 stages of germination with a small ulcerative defect, wedge-shaped resection is possible.
With penetrating duodenal ulcer: with limited damage, duodenoplasty and selective proximal vagotomy are recommended. Patients with invading large pyloroduodenal ulcers usually undergo an antrumectomy in combination with a truncal vagotomy. It is possible to leave the bottom of the ulcer in the involved organ.

In the postoperative period, patients are prescribed anti-inflammatory therapy, which accelerates the scarring of the defect that has arisen in the affected organ. In case of complicated penetration of an ulcer with the presence of internal fistulas, complex simultaneous operations are performed on the stomach, duodenum, biliary tract, colon and other organs to eliminate the fistulous tract.

Forecast and prevention

The outcome of the disease is determined by the stage of germination and the timeliness of the treatment started. The prognosis is relatively favorable in patients with the first stage of penetration; serious complications may occur in the second and third stages. For the prevention of pathology, it is necessary to carry out timely and complex therapy of peptic ulcer of the duodenum and stomach, to conduct dispensary monitoring of patients who have undergone surgical treatment of ulcers.