An ulcer perforation is a tissue breakdown that affects all wall sections of an organ, creating a hole in the organ wall. Ulcers are the cause of this tissue destruction. The stomach or small intestine are most commonly affected by ulcers and, therefore, ulcer perforations.
What is an ulcer perforation?
An ulcer is an ulcer. In most cases, it is an ulcer of the stomach or small intestine. A gastric ulcer is also called a ventriculi ulcer, and the intestinal ulcer is also called a duodenal ulcer. The type of perforation can also be distinguished in the case of an ulcer perforation. In a free perforation, there is a continuous connection between the interior of the organ and the abdominal cavity. In a covered perforation, the hole in the wall is covered by adjacent organs and thus remains closed.
Causes
By definition, an ulcer always underlies an ulcer perforation. There are many causes of ulcers in the gastrointestinal tract. Many ulcers are caused by gastritis, which is inflammation of the lining of the stomach. Non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen, diclofenac or acetylsalicylic acid reduce the formation of mucus that protects the stomach. As a result, the aggressive stomach acid attacks the mucous membrane of the stomach and ulceration occurs. This cause is particularly insidious because the painkillers also numb the pain of the ulcer. Even pronounced ulcers often go unnoticed by sufferers. Toxic substances such as nicotine or alcohol also irritate the mucous membranes of the gastrointestinal tract. In addition, ulcers of the stomach can be the result of diseases such as hyperparathyroidism or Zollinger-Ellison syndrome. Likewise, stress can promote gastric ulceration. The familial accumulation of the disease also indicates a hereditary predisposition. The causes of small bowel ulcer are similar to those of peptic ulcer.
Symptoms, complaints, and signs
Ulcer bleeding occurs in only about five to ten percent of all ulcer perforations. This is noticeable in the form of vomiting blood or spitting blood. In any case, the perforation of the ulcer results in an acute abdomen. The leading symptoms include violent and sudden abdominal pain. The general condition is poor. The pain of a perforated peptic ulcer is located in the epigastric region. A perforated ulcer of the small intestine usually causes pain in the right upper quadrant of the abdomen. Often, the pain is accompanied by vomiting. The abdominal wall shows reflex defensive tension. The abdomen is board hard on palpation. In addition, the entire abdominal cavity is distended. There may also be fever.
Diagnosis and course of the disease
The first clues to ulcer perforation are provided by the symptoms. Patients may report pain in the stomach or intestinal area in their medical history. Pain medications in the medication history also indicate an ulcer and possible perforation. The history is followed by palpation and auscultation of the abdomen. The abdomen is hard and tender to pressure. If paralytic ileus has already occurred due to severe inflammation, no bowel sounds can be heard through the stethoscope. Free fluid in the abdomen can be detected by ultrasound examination. In addition, an x-ray of the entire abdomen is usually taken while the patient is lying down and standing up. The chest is also x-rayed. This often reveals a crescent of air under the diaphragm. If the findings are still unclear despite these examinations, an esophago-gastro-duodenoscopy can be performed. In this procedure, the esophagus, stomach and duodenum are examined with an endoscope. The endoscope consists of a flexible tube with a video camera at the tip. This allows a good assessment of the condition of the organs and especially the condition of the organ walls. If the ulcer perforation is not treated, it can lead to inflammation of the peritoneum (peritonitis) and blood poisoning (sepsis). In peritonitis, much fluid is lost through the peritoneum due to the inflammatory processes. Proteins also leak into the abdominal cavity. Edema forms and hypovolemic shock may occur. Very high fever, rapid breathing, impaired consciousness and shock indicate sepsis. Both conditions are life-threatening.
Complications
Ulcer perforation causes an acute abdomen, which can cause various complications as the disease progresses. Typically, inflammation and abscesses occur in the abdomen, leading to sepsis in an unfavorable course. This is accompanied by a deterioration in the patient’s general condition and persistent pain in the affected region. If the ulcer perforation occurs in the region of the small intestine, complaints such as vomiting, intestinal obstruction and occasionally high fever are also present. In about five to ten percent of cases, ulcer perforation causes ulcer bleeding. This is associated with vomiting of blood and, as it progresses, can lead to anemia and resulting complications. Surgery may be associated with injury to tissue structures, infection, bleeding, and postoperative hemorrhage. Wound healing disorders can also occur after surgery, which can have serious consequences due to the location of the perforation. If a catheter is placed, there is a risk that inflammation will occur. Major injuries may also occur, which may be accompanied by sensory disturbances and nerve damage. Concomitantly prescribed drugs are always associated with certain risks and side effects.
When should you see a doctor?
The affected person is dependent on treatment by a physician for ulcer perforation. There can be no self-healing in this disease, so treatment by a doctor must always be performed. Therefore, even at the first symptoms or complaints, a medical professional should be consulted to treat the disease. As a rule, the doctor should be contacted if the affected person suffers from bloody vomiting or if he spits up blood. There is also very severe pain in the abdomen, so that the quality of life is also significantly reduced by this disease. In many cases, diarrhea or fever may also occur, so that the usual symptoms of flu also appear. The ulcer perforation should be treated directly in a hospital. Therefore, either call an emergency physician or go directly to the hospital.
Treatment and therapy
First, surgical closure of the wall defect is performed. In this process, the damaged tissue parts are removed and the open areas are sutured over with healthy tissue. In addition, a procedure called peritoneal lavage is performed. This involves flushing the abdominal cavity to remove the necrosis and any pathogens that may have entered. During peritoneal lavage, the abdominal cavity in the area below the navel is punctured with a large cannula. Body-warm Ringer’s solution or saline is then introduced into the abdomen through a catheter. The irrigation fluid finally runs back into the infusion bottle according to the siphon principle.
Prevention
Without ulceration, there is also no ulcer perforation. For prevention, it is therefore recommended to first omit all foods and drinks that irritate the stomach. Very spicy or very hot foods, as well as high-proof alcohol and coffee, are not particularly well tolerated. To prevent a stress-related ulcer, relaxation exercises or stress management can be helpful. Anyone who takes medications that are harmful to the stomach over a long period of time (for example, non-steroidal anti-inflammatory drugs) should discontinue them after consulting with the person treating them or replace them with alternatives that are gentler on the stomach. If the gastric mucosa is attacked by the bacterium Helicobacter pylori, antibiotics may be necessary. If there is a genetic risk, it may be advisable to take acid blockers or proton pump inhibitors as a preventive measure. If an ulcer develops despite all these preventive measures, it should be treated early or surgically removed. This is the only way to prevent perforation.
Aftercare
The perforation of an ulcer is a serious condition that requires consistent follow-up care. This depends closely on the location and is discussed with the general practitioner or specialist. Thus, in the case of gastric ulcer, the internist or gastroenterologist is the right contact for control examinations or the follow-up measures carried out by the patient. In the case of gastric ulcers, for example, which will be discussed here as an example, gastroscopy is necessary at regular intervals determined by the physician. Here, an ulcer can be quickly detected as a recurrence and adequately treated.Bacteria such as Helicobayter pylori, which can cause gastritis and subsequently ulcers, are also detected during this follow-up. Nutrition is also of great importance after ulcer therapy. Thus, the diet must not stress the sensitive area even during the follow-up phase. Fatty and spicy dishes should be avoided, as should acidic drinks, such as freshly squeezed orange juice. Lovers of fragrant drinks should ideally limit their consumption in favor of herbal tea, and still water is more recommended than carbonated products. Alcohol and, above all, nicotine should be avoided, at least during the follow-up period. Stress is often a factor in the development of an ulcer. Therefore, reduction of stress factors as well as relaxation techniques and yoga are also helpful in follow-up care.
Here’s what you can do yourself
An ulcer perforation is a medical emergency. The most important action is to contact emergency medical services. Until the emergency physician arrives, the patient must lie down quietly and cool the affected area. After the wall defect has been surgically closed, rest and gentle treatment are the order of the day. The affected area must be checked regularly, which is why hospitalization is the first step. The patient should consult with the physician during this time to determine possible causes for the ulcer perforation. In most cases, there is an underlying ulcer, which must be removed. If necessary, general measures are useful. Diet and lifestyle changes reduce the risk of ulcers and improve overall well-being. Sports and physically strenuous work must be avoided for the first two to four weeks after surgery. The diet must be changed immediately after surgery. Patients must consume plenty of fresh fruits and vegetables, whole grains, fish, dairy products and legumes. The intake of high-quality proteins and vitamins optimally supports the body’s regeneration process. Further measures can be mentioned by the physician who has taken over the treatment of the actual ulcer.
