Perforated Ulcer of the Stomach and Duodenum

A perforated ulcer of the stomach and duodenum is a serious complication of peptic ulcer disease, in which a hole is formed in the wall of the stomach or intestine, leading to the penetration of exclusively acidic contents into the free abdominal cavity. This condition requires immediate medical attention and surgery.

About 10% of all ulcers are complicated by perforation, that is, a hole in the stomach or duodenum. Perforation of an ulcer can manifest as a sharp exacerbation of a peptic ulcer 3-4 days before its onset. When examining the patient, you may notice muscle tension and local soreness in the area of ​​the ulcer. Then, most often with physical stress, a sharp “dagger” pain occurs in the epigastrium, which quickly spreads throughout the abdomen. The pain intensifies with movement. In the initial stage of the disease, a single reflex vomiting may occur.

Physical symptoms include a forced position of the patient with the knees brought to the stomach and a pained, frightened expression on the face. The tongue becomes dry and coated. The abdomen becomes sharply tense and painful in all its parts. Positive symptoms of peritoneal irritation can also be identified during examination. The appearance of a crescent of air under the diaphragm on an X-ray examination of the abdomen can confirm the presence of perforation (in 60-80% of cases, depending on the time that has passed since the perforation).

The disease of perforated ulcer goes through three stages. The reflex stage covers a period of up to several hours to several days before perforation. In the stage of imaginary well-being (6-12 hours), the intensity of the pain syndrome decreases, the patient’s condition improves, and the abdomen becomes softer and less painful. However, peritonitis (inflammation of the peritoneum) continues to develop, and the patient's condition gradually worsens. The diagnosis is usually based on a history of ulcers (80-90% of cases), characteristic “dagger” pain, features of the abdominal examination and the presence of tachycardia at normal temperature.

Treatment of a perforated ulcer is surgical and requires immediate intervention. Before surgery, premedication with antibiotics and gastric antisecretory drugs is usually performed to reduce the acidity of gastric contents. Surgery involves closing the opening in the stomach or intestines and sometimes removing part of the ulcerative lesion. After surgery, the patient is prescribed antibiotics to prevent infection and antiulcer medications to heal the ulcer.

Recovery from surgery may take some time. It is important to follow your doctor's recommendations regarding diet and medications. In the case of a perforated ulcer, seeking medical attention early can be dangerous as it is potentially life-threatening. Therefore, if symptoms indicating perforation of the ulcer appear, you should immediately consult a doctor or call an ambulance.