If the lining of the stomach is damaged, this can lead to a gastric rupture or perforation. An open gastric perforation is almost always a medical emergency.
What is a gastric perforation?
In a gastric perforation (also known as gastric perforation in medical terms), the wall of an affected person’s stomach breaks. A distinction can be made between open and covered gastric perforation; if an open gastric perforation is present, one of the risks is that the contents of the stomach will spill into the abdominal cavity. An open gastric perforation usually requires immediate, emergency medical measures. A covered gastric perforation is characterized by adhesions in the stomach that make contact with adjacent organs. In most cases, an open gastric perforation is associated with much more severe symptoms than a covered perforation; common symptoms of an open gastric perforation include severe and stabbing pain in the upper abdomen, which in isolated cases may radiate to the shoulders.
Causes
In most cases, gastric rupture in the affected person is caused by gastric ulcers: gastric ulcers lead to damage of the gastric mucosa, which in healthy people protects the stomach wall from gastric acid. If this protection is lost, the stomach wall is vulnerable at corresponding points; a severe consequence is gastric rupture. Other causes that can be behind a gastric perforation include, for example, injuries in the course of gastroscopy. Accidental ingestion of corrosive substances can also result in gastric perforation. Furthermore, a gastric perforation can be caused by long-term medication intake; various active ingredients have a tendency to attack the gastric mucosa, which increases the risk of a gastric perforation. Drugs that can have a corresponding effect include cortisone (an active component used as an anti-inflammatory, for example). Finally, in very rare cases, gastric rupture can be the result of cancer affecting the stomach.
Symptoms, complaints, and signs
An open gastric rupture typically manifests as severe, stabbing pain in the center of the upper abdomen. The pain may radiate to the chest and shoulder region. Usually, the symptoms occur quite suddenly – in individual cases, however, they are preceded by a longer history of illness. If stomach contents enter the abdominal cavity, there is a risk of peritonitis. The pain spreads into the abdominal cavity, resulting in a protective posture. The hardening of the abdominal wall is also characteristic, accompanied by severe pressure pain and an increasing feeling of illness. In the case of a covered perforation, less pronounced symptoms occur. Mild pain is usually noticed, increasing in intensity over the course of several days. An open gastric perforation does not resolve on its own. It is a medical emergency that requires medical attention. Otherwise, symptoms increase and the patient’s life is in acute danger. A covered gastric perforation also takes a severe course if left untreated, with increasing pain and a growing feeling of illness that significantly affects well-being. With early treatment, the signs of illness disappear after a few days. The feeling of illness may persist for one to two weeks, depending on the severity of the perforation.
Diagnosis and course
A physician can initially make a tentative diagnosis of gastric perforation based on a patient’s typical stabbing pain; information regarding the individual’s medical history and initial symptoms is also usually incorporated into a tentative diagnosis. The suspicion of a gastric perforation can be checked in a next step with the aid of an X-ray; if free air can be seen in the abdominal cavity, this indicates that a gastric perforation is present.While a covered gastric perforation is often comparatively mild and has good chances of recovery, various complications can occur in the course of an open gastric perforation: For example, advancement of the stomach contents into the abdominal cavity can cause life-threatening peritonitis; associated with such an inflammation is often severe spreading abdominal pain and a hardened abdominal wall.
Complications
Life-threatening complications can occur as a result of gastric perforation. In addition to severe pain, a rupture can cause peritonitis, resulting in fever, constipation, and possibly even bowel obstruction. Rarely, septic shock can occur with fluctuations in blood pressure, respiratory problems, and circulatory failure. In severe cases, peritonitis leads to death. Another possible complication is blood poisoning. Also associated with pain and fever symptoms, sepsis can lead to multiple organ failure and even affect nerve and brain function. If the brain is affected, there may be permanent limitations in memory and learning. If the nervous system is affected, paralysis and chronic pain may occur. In the case of a covered perforation, such as occurs with adhesions, fistula formation with neighboring organs may occur. As a result, severe organ damage may occur. If the gastric perforation is treated in time, no further complications usually occur. Sometimes, however, the affected person has to change his or her diet. In addition, the prescribed drugs can cause side effects and allergic reactions. To avoid complications, a doctor should be consulted immediately if a gastric rupture is suspected.
When should you see a doctor?
Sudden pain in the upper abdomen, pain to the touch or hardening of the abdominal wall are signs of health problems. A visit to the doctor is necessary so that the cause of the discomfort can be determined. In the case of a gastric rupture, there is a medical emergency that must be treated as quickly as possible. Therefore, if the occurring symptoms increase rapidly in intensity in a short time, an emergency medical service is required. Until the rescue service arrives, first aid measures must be administered by the persons present in order to ensure the survival of the affected person. In the event of an increasing feeling of illness, general malaise and internal weakness, a doctor is required. If cramps, bleeding, vomiting or nausea occur, consultation with a physician is indicated. In case of fever, disturbances of the heart rhythm, a loss of appetite or problems of the digestive tract, a control visit to a doctor should take place. If the affected person adopts a protective posture, the need for sleep increases and he suffers from faintness and fatigue, a doctor should be consulted. If the usual performance level drops, professional or everyday obligations can no longer be fulfilled, or sleep disturbances set in, a visit to the doctor is necessary. A loss of well-being, increased body temperature and inner restlessness are signs of an irregularity. If the complaints persist for several days or gradually increase in intensity, a doctor is needed.
Treatment and therapy
Medical treatment of a gastric perforation depends, among other things, on the form of the present perforation and individually occurring complications in the course of the disease. If an open gastric perforation requires emergency medical treatment, surgical intervention is unavoidable in most cases; in the course of an ensuing operation, the perforation on the stomach wall is usually closed first. Subsequent irrigation of the abdominal cavity frees it from gastric contents that were able to empty out of the stomach in the course of the gastric perforation – such irrigation after an open gastric perforation helps to reduce the risk of peritonitis or to prevent the progression of an inflammation that has already occurred. The surgical procedures required for open gastric perforation are usually performed under general anesthesia and are minimally invasive (the abdominal wall does not have to be opened extensively through an incision). If a person affected by an open gastric perforation has severe peritonitis, this is often monitored with intensive care.Covered gastric perforation does not require surgical intervention in many cases; occasionally, the stomach is relieved here by a gastric tube.
Outlook and prognosis
An open gastric perforation is life-threatening. If timely treatment in the form of surgery is not obtained, patients are at risk of death. Early intervention is always preferable. 24 hours after the rupture, the probability of survival is only 50 percent. It decreases with each additional hour of waiting. The general condition and age of the patient are also relevant to recovery. Certain pre-existing conditions can reduce the likelihood of recovery. If the stomach contents get into the abdominal cavity, the chances of recovery deteriorate considerably. Inflammation may develop. A much better prognosis results from a covered gastric perforation. Here, there are only connections to other organs. The physician decides on the therapy on the basis of an X-ray image. Surgical intervention is not always necessary. Conservative therapies sometimes promise a cure as well. A covered gastric perforation is usually not a life-threatening situation. Successful acute treatment does not automatically lead to complete recovery. Some patients can no longer consume all the foods they are accustomed to, resulting in minor to major restrictions in everyday life. To what extent intolerance is present after gastric surgery is unpredictable.
Prevention
Since gastric perforation is caused by gastric ulcers in most cases, early treatment of corresponding ulcers in particular can prevent perforation of the stomach wall. If in the individual case, for example, long-term medication intake has already led to stomach damage, medical advice regarding alternative preparations can help to prevent a gastric perforation.
Aftercare
Follow-up care for gastric rupture depends on the severity of the condition. In milder cases, regular examinations are sufficient to clarify whether the healing process is proceeding as expected. Physical exertion should be avoided, and those affected are sometimes dependent on the help of family and friends in everyday life. The usual routine should be resumed slowly, and a change in diet with a light, low-acid diet is recommended to protect the damaged stomach. Every patient should also discuss with his or her attending physician what should be taken into account when changing the diet. In addition, symptoms such as frequent heartburn, stabbing stomach pain or vomiting blood must be related to the previous history and clarified in the future. In more severe cases, closely timed checkups are needed to avert further complications in a timely manner.
What you can do yourself
People with a gastric rupture are experiencing a medical emergency. Affected persons behave correctly if they immediately call an emergency physician or observers of what is happening take over this activity. During a gastric rupture, there is a sudden physical collapse. In some patients, this acute condition has already been apparent for a long time due to various symptoms. Therefore, to avoid gastric rupture, a doctor should be consulted in time. If the emergency occurs, first aid care is necessary for the organ failure to prevent premature death of the patient. As far as possible, excitement, well-intentioned advice and discussion should be avoided. The affected person should refrain from unnecessary movements until the emergency physician arrives and try to remain calm despite the severe pain. Steady breathing is necessary to ensure that the organism is supplied with sufficient oxygen. If unconsciousness occurs, bystanders have a duty to check that breathing is secured. If it stops, artificial respiration must be initiated via the mouth-to-mouth technique. Due to the discomfort, the patient automatically adopts a protective posture. This is a natural reaction of the human being, which ensures his survival. Immediate surgical intervention is necessary to prevent further disease or inflammation. There are no alternative options for a gastric rupture.
