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.
- Surgical diseases
- Abscess
- Abscess appendicular
- Abscesses of the abdominal cavity
- Abscess of the Douglas space
- Intestinal abscess
- Abscess of the lung
- Soft tissue abscess
- Abscesses of soft tissues after injection
- Abscess of liver
- Amoebic liver abscess
- Prostate adenoma
- Actinomycosis
- Aneurysm
- False aneurysm
- True aneurysms
- Aneurysm of the aortic arch
- Aneurysm of descending thoracic aorta
- Dissecting Aneurysm
- Aneurysm of the abdominal aorta
- Aneurysm of peripheral vessels
- Arteriovenous aneurysm
- Aneurimas of the heart
- Appendicitis acute
- Perforation of the appendage
- Appendicular infiltration
- Pielephlebitis
- Atheroma
- Bronchoectasis
- Varicose veins
- Varicose veins of the spermatic cord
- Dropsy of testis and spermatic cord
- Rectal prolapse
- Gangrene gas
- Gangrene lung
- Hemorrhoids
- Hydradenite
- Gynecomastia
- Hernia
- Internal hernias
- Hernias of the esophagus
- External hernias
- Herniated hernias
- Herniated hernia
- Hernia of the white line
- Hernia postoperative ventral
- Herniated hernia
- Rare hernias
- Pincushion
- Phlegmon hernial sac
- False infringement of a hernia
- Hernias with inflammation
- Dumping syndrome
- Diverticulum
- Esophagus diverticulum
- Cervical diverticulum
- Bifurcation diverticulum
- Epiphrenic diverticulum
- Epiphrenic diverticulum
- Diverticulum of the stomach
- Diverticulum of the duodenum
- Meckel's diverticulum
- Jaundice mechanical
- Bile duct stones
- Ventilated stone of choledoch
- Papillotenosis
- Stricture of bile ducts
- Cancer of the head of the pancreas
- Cholelithiasis
- Urinary retention acute
- Zollinger-Ellison syndrome
- Foreign bodies of bronchi
- Foreign bodies of the stomach
- Foreign bodies of the esophagus
- Foreign bodies of soft tissues
- Carbuncle
- Brushes and fistulas of the neck are lateral
- Cysts and fistulas of the neck median
- Colitis ulcerative ulcerative
- Coccygeal epithelial passage
- Cryptorchidism
- Bleeding
- Bleeding internal
- Bleeding gastrointestinal
- Varicose veins
- The Mallory-Weiss Syndrome
- Bleeding into the abdominal cavity
- Bleeding pulmonary
- Bleeding external
- Parenchymal hemorrhage
- Crohn's disease
- Lymphadenitis
- Lymphangitis
- Mastitis
- Putrefactive mastitis
- Acute non-lactational mastitis
- Chronic mastitis
- Megacolon
- Mediastinitis
- Intestinal obstruction
- Paralytic intestinal obstruction
- Mechanical intestinal obstruction
- X-ray diagnostics
- Specific types of intestinal obstruction
- Ingrown throat
- Frostbite
- Local cooling
- Burn
- Occlusion of the main arteries
- Acute occlusion of the vessels of the extremities
- Acute occlusion of mesenteric vessels
- Chronic occlusions of arterial vessels
- Obtiterating atherosclerosis
- Aortic ileal type
- Hips and popliteal type
- Peripheral type
- Occlusion of aortic arch branches
- Occlusion of carotid arteries
- Occlusion of the subclavian artery
- Takayasu's syndrome (absence of pulse)
- Chronic occlusion of mesenteric vessels (abdominal toad)
- Stenosis of the renal arteries
- Obliterating thrombangitis
- Raynaud's disease
- Orcoepididymitis
- Acute abdomen
- Acute pancreatitis
- Chronic pancreatitis
- Acute Cholecystitis
- Panaritium
- Panaritium cutaneous
- Paronichy
- Panaritium subungual
- Panaritium tendinous
- Panaritium articular
- Panaritium bone
- Penetrating ulcer of the stomach and duodenum
- Peritonitis
- Peritonitis chronic
- Piopevneumotorax
- Pneumothorax spontaneous
- Postcholecystectomy syndrome
- Covered perforation
- Bedsore
- Prostatitis
- Wounds
- Fistulas of the rectum
- Stenosis of the outlet stomach
- Fracture of anus
- Urethritis
- Phimosis, paraphimosis
- Phlebothrombosis
- Occlusion of subclavian vein
- Phlegmon
- Furuncle
- Cholangitis
- Electric trauma
- Empyema of the pleura
- Congenital intestinal obstruction
- Atresia of the anus
- Congenital cholangiopathy of newborns
- Pylorostenosis
- Embryonic hernia (hernia of umbilical cord)
- Exstrophy of the bladder
- Dropsy of shells of testis and spermatic cord
- Surgical diseases of the chest
- Congenital diaphragmatic hernia
- Congenital cysts of the lungs
- Pneumothorax
- Tracheophishoprine fistula
- Mastitis of newborns
- Acute hematogenous osteomyelitis
- Peritonitis in newborns
- Acute paraproctitis
- Necrotic phlegmon of newborns
Comments
When commenting on, remember that the content and tone of your message can hurt the feelings of real people, show respect and tolerance to your interlocutors even if you do not share their opinion, your behavior in the conditions of freedom of expression and anonymity provided by the Internet, changes Not only virtual, but also the real world. All comments are hidden from the index, spam is controlled.