gastric perforation
Introduction
Introduction to gastric perforation Gastric perforation is most common in gastric ulcers and is the most serious complication of ulcer disease. It is one of the most common acute abdomen in general surgery, and often occurs on the small curved side of the anterior wall of the antrum. Gastric perforation is the development of gastric lesions to the depth, thinning of the stomach wall, or sudden increase of pressure in the gastric cavity, can be worn to the abdominal cavity, food, stomach acid, duodenal juice, bile, pancreatic juice and other chemically stimulating gastrointestinal The content flows into the abdominal cavity, causing severe abdominal pain, causing acute diffuse peritonitis. basic knowledge The proportion of patients: the incidence of peptic ulcer patients is about 0.1% Susceptible people: no special people Mode of infection: non-infectious Complications: shock, abdominal pain
Cause
Cause of gastric perforation
Cause
Peptic ulcer (80%):
The most common cause of gastric perforation is peptic ulcer. As the ulcer deepens, it penetrates the muscle layer, the serosal layer, and finally penetrates the stomach or the wall of the duodenum to cause perforation. Several different consequences can occur after perforation. For example, before the perforation, the ulcer base has adhered to adjacent organs such as pancreas and liver, forming a penetrating ulcer, which is a chronic perforation. In a few cases, the ulcer base adheres to the transverse colon, and the perforation forms a gastric colon fistula. Most of the above two cases occur in the stomach, and the duodenal ulcer is perforated in the posterior wall. If the ulcer is perforated and quickly adheres to the omentum or nearby organs, an abscess can be formed around the perforation.
Trauma (18%):
There is also a small amount of perforation of gastric cancer, occasionally seen in gastric lavage, gastroscopy, abdominal impact and so on.
Prevention
Gastric perforation prevention
(1) Patients with gastroduodenal ulcer should be diagnosed by early gastroscopy to determine the nature of the ulcer, the location and severity of the ulcer, and timely medical treatment.
(2) If the systemic medical treatment is ineffective or the recurrence of ulcers is healed, it should be treated with early surgery.
(3) Regular diet, eat less meals, avoid irritating foods such as cold and spicy, stop smoking and limit alcohol, and relieve mental stress.
(4) banned drugs that damage the gastric mucosa such as aspirin, indomethacin and other non-steroidal anti-inflammatory drugs, hormone drugs. If it is necessary to apply, it should be used to protect gastric mucosal drugs and acid-suppressing drugs.
Complication
Gastric perforation complications Complications, shock, abdominal pain
1, severe chemical stimulation after shock perforation can cause shock symptoms. The patient developed irritability, shortness of breath, fast pulse, and unstable blood pressure. As the degree of abdominal pain is reduced, the situation can be stabilized. Thereafter, as bacterial peritonitis worsens, the condition worsens, and in severe cases, infection (poisoning) shock can occur.
2, acute peritonitis full abdominal muscle tension as a plate, tenderness is significant, refused to press, the whole abdomen can lead to rebound pain.
Symptom
Symptoms of gastric perforation common symptoms fever nausea and vomiting abdominal pain shock leukocytosis
First, abdominal pain
Sudden onset of severe abdominal pain is the most frequent and most important symptom of gastric perforation. Pain initially begins in the upper abdomen or perforated area, often with a knife-cut or burning-like pain, usually persistent, but also aggravated. The pain quickly spreads throughout the abdomen and can spread to the shoulders with a stinging or sore feeling.
Second, shock symptoms
At the beginning of perforation, patients often have a certain degree of shock symptoms, and the disease progresses to bacterial peritonitis and intestinal paralysis. Patients may experience toxic shock again.
Third, nausea, vomiting
About half of the patients have nausea and vomiting, which is not severe. The vomiting is aggravated during intestinal paralysis, and there are symptoms such as bloating and constipation.
Fourth, other symptoms
Fever, rapid pulse, increased white blood cells, etc., but generally appear several hours after perforation.
Examine
Gastric perforation examination
1. Physical examination: abdominal wall tenderness, rebound tenderness, muscle tension and peritonitis symptoms, liver dullness area shrinks or disappears.
2. Abdominal puncture to extract purulent fluid, the diagnosis is more clear.
3. X-ray examination, about 75% to 80% of cases can be seen in the crescent-shaped free gas. The free gas under the armpit is an important evidence for the diagnosis of gastric perforation. Combined with the patient's history of ulcer and the recent history of ulcer disease, severe abdominal pain after perforation and acute diffuse peritonitis, abdominal cavity puncture extracts digestive juice containing gastrointestinal contents. Difficult to diagnose.
4. B ultrasound, CT examination, diagnosis of the disease.
Diagnosis
Diagnosis of gastric perforation
Differential diagnosis
The pneumoperitoneum caused by perforation of the gastrointestinal tract needs to be differentiated from the normal anatomical variant metastatic colon. The position of the rotation under fluoroscopy can be identified.
The traditional diagnostic method for gastrointestinal perforation is to take the abdominal X-ray film and observe the presence or absence of free gas under the armpit and abdominal wall as the main diagnostic basis, but the accuracy is limited.
Acute pancreatitis: Most of the abdominal pain is located in the upper abdomen and is radiated to the back. The abdominal muscles are less tense, the serum and abdominal puncture fluid amylase is increased obviously. X-ray examination has no free gas under the armpit. CT examination shows pancreatic swelling. Peripancreatic exudate and the like.
Acute cholecystitis: paroxysmal or persistent pain in the upper right abdomen is exacerbated with chills and fever. The main signs are tenderness and rebound tenderness in the right upper quadrant, and sometimes the enlarged gallbladder can be touched. Ultrasound suggests calculus or acalculous cholecystitis.
Acute appendicitis: After perforation of the ulcer, the digestive juice flows along the right colon to the right lower abdomen, causing signs of right lower abdominal pain and peritonitis, which is easily confused with acute appendicitis. However, the acute symptoms of acute appendicitis are mild. There is no severe pain in the upper abdomen during the attack. The abdominal signs are not mainly in the upper abdomen. Generally, it is limited to the right lower abdomen. X-ray examination has no free gas under the axilla.
In addition, it needs to be differentiated from mesenteric ischemic disease, ectopic pregnancy rupture, ovarian cyst torsion, acute myocardial infarction.
