Complications | Stomach Ulcer

Complications

If a gastric or duodenal ulcer breaks through the stomach or intestinal wall and the gastric juice is connected to the free abdominal cavity (peritoneal cavity), this is called an ulcer perforation (gastric perforation). In 10% of patients with a duodenal ulcer and in 2-5% with a ventriculous ulcer, such an ulcer perforation occurs in the course of the disease.More frequent are breakthroughs in NSAID-induced ulcers, because they are detected and treated later due to the painless course. A perforation of the stomach or intestinal wall can lead to life-threatening peritonitis, which must be treated surgically as soon as possible.

In some cases, an ulcer can also “break into” an adjacent organ, which is known as ulcer penetration (“covered perforation”). For example, due to the close proximity, the pancreas may be affected if a duodenal ulcer extends beyond the outer wall of the intestine. In rare cases, a stomach ulcer can also break into the liver (hepar).

If an ulcer hits a blood vessel and damages it, ulcer bleeding can occur. This complication is still associated with a mortality rate of 10%. Hemorrhage can appear as hidden (occult) blood in the stool, as tarry stool (mälena) or even as haematemesis.

The therapy consists of injecting the ulcer with drugs such as adrenaline during a gastrointestinal endoscopy, which stops the bleeding because adrenaline tightens the bleeding vessel. Even if the bleeding stops on its own, the ulcer is still injected to prevent repeated (recurrent) bleeding. Only if haemostasis cannot be stopped by endoscopy in any way, the bleeding must be stopped during open surgery.

This complication is more frequent in the case of peptic ulcers located on the back wall of the stomach, where the anatomical proximity to a gastric artery (artery) tends to cause particularly heavy bleeding. The gastric ulcer is typically located at the exit of the stomach. In the picture below, the stomach wall is shown in cross section and you can see how deep the stomach ulcer extends.

If the mucous membrane is damaged, this can extend into the connective tissue underneath, which can lead to gastric bleeding.

  • Mucosa (mucous membrane)
  • Ulcer (stomach ulcer)
  • Submucosa (connective tissue layer)
  • Blood Vessels

A rarer complication of a stomach ulcer is a narrowing of the stomach outlet or duodenum (stenosis). These usually occur in the area of the stomach outlet (pylorus) and the beginning of the small intestine (bulbus duodeni), when repeated (recurrent) ulcers occur in this area, resulting in scarring and tissue shrinkage. The typical initial symptom of this complication is repeated vomiting, as the food ingested cannot pass through the stomach or intestine in the area of the narrowing.