Perforated ulcer

A perforated ulcer is a rapidly occurring message of the lumen of the stomach or duodenum with a free abdominal cavity. About 10% of ulcers are complicated by perforation.

Symptoms, course. 3-4 days before the perforation in the ballroom, there is a sharp exacerbation of peptic ulcer, while examining - some muscle tension and local percussive soreness in the area of ​​the ulcer. Then suddenly (more often with physical exertion) there is a sharp "dagger" pain in the epigastrium, which quickly spreads throughout the abdomen. The pain increases sharply when moving. In the initial stage of the disease there may be a single vomiting of a reflex character. The position of the patient is more often forced-with knees brought to the stomach. The facial expression is suffering, frightened. The tongue is dryish, overlaid. The abdomen is sharply strained ("flaky"), it is painful in all parts, the symptoms of irritation of the peritoneum are sharply positive. Hepatic dullness absent or smoothened. Tachycardia. Radiologic examination - sickle air under the diaphragm (depending on the time that has passed since the perforation, in 60-80%).

There are 3 stages of the disease: reflex (up to 6 hours), imaginary well-being (6-12 hours) and progression of peritonitis (over 12 hours). In the stage of imaginary well-being, the intensity of the pain syndrome decreases somewhat, the patient's condition improves, the stomach becomes softer and less painful, however, the peritonitis progresses, the condition of the patients gradually worsens.

In the diagnosis help: ulcer history (80-90%), "dagger" pain, "doskobrazny" stomach, tachycardia at normal temperature.

Treatment operative. Before the operation - premedication with antibiotics. When diffuse purulent peritonitis in somatically burdened patients with perforation of acute ulcers, suturing of the perforation is shown. With gastric localization of ulcers before suturing, it is advisable to take a piece from the edge of the ulcer for histological examination (perforation of the cancer tumor?). In other cases, perforation of duodenal ulcers use vagotomy (various options) with draining operations (better excision of the ulcer and suturing defect in the transverse direction - such as pyloroplasty according to Heineke-Mikulich). When perforated, gastric ulcers produce a resection of the stomach.

Prevention: timely treatment (including surgical) of peptic ulcer. If the patient refuses the operation or is unable to perform it at a short time from the moment of perforation, the Taylor method can be used - constant aspiration of the gastric contents with the help of a thin gastric probe, parenteral fluid administration, massive antibiotic therapy.