Penetrating ulcer of the stomach and duodenum

Penetrating ulcer of the stomach and duodenum - penetration of the ulcer into a number of located organs and tissues. There are 3 stages of penetration: the stage of penetration of the ulcer through all layers of the organ wall, the stage of fibrous fusion with the underlying tissues and the stage of complete penetration. The clinical picture depends on the location of the ulcer and the organ into which it penetrates. Gastric ulcers often penetrate into the small omentum, with marked pain syndrome, poorly susceptible to conservative therapy, almost constant pain, the connection with food intake is not clearly expressed. Duodenal ulcers often penetrate the pancreas; Irradiation of pain in the lumbar region, hyperamilazemia. Penetration of the ulcer into the hepatic-duodenal ligament can lead to the development of mechanical jaundice. Gastric ulcers can penetrate into the abdominal wall (rarely), cardiovascular and subcardial ulcers of the stomach with penetration into the small omentum sometimes cause the occurrence of angina pain.

In the diagnosis, the main importance is: X-ray (outlet of the niche for the contour of the stomach during a profile study) and fibrogastroscopy (deep ulcer defect).

Complications: perforation of the ulcer into the free abdominal cavity with the development of diffuse peritonitis, profuse bleeding from the large vessels of the small omentum or pancreatic duodenal artery.

Treatment operative. Its expediency is dictated by the severity and frequency of complications, the ineffectiveness of conservative therapy. The operation should be performed only after a course of antiulcer treatment. When the stomach ulcer is resected, with duodenal ulcer - selective proximal vagotomy or stem vagotomy in combination with an antrum-resection.

The prognosis is favorable. Prevention: timely adequate (including surgical) treatment of peptic ulcer.