Dr. Ertan Beyatlı

Gastric Perforation (Gastric Perforation)

(Update: ) - Digestive System Diseases

Gastric perforation is the opening of the stomach wall towards the abdominal cavity and the discharge of stomach contents into the abdomen. High life-threatening has. Requires immediate intervention. Also, stomach rupture or stomach rupture Gastric perforation It is also called.

Why is the stomach pierced?

There are four main causes of gastric perforation:

  • Ulcer perforation
  • Perforation due to the process
  • Accidental puncture
  • Perforation without cause

Gastric perforation due to gastric ulcer is the most common cause (60%). Stomach ulcer When treated inadequately, the stomach wall may become thinner and perforate over time. Already have a stomach ulcer two of the most important complications stomach bleeding (50%) and stomach perforation (30%). There are no other organs supporting the anterior wall of the stomach. Therefore, 60% of punctures occur in the anterior wall of the stomach. Bleeding stomach ulcers are usually found on the back wall of the stomach.

Gastric perforation due to a human-handed procedure or surgery is called "iatrogenic perforation" in medical language. For example, endoscopy, insertion of a nasogastric tube, closed surgery. Such punctures can be detected at an early stage. Therefore, it is easily treated and has a low risk.

Perforation during accident and trauma is called Traumatic stomach perforation. Penetrating and cutting tool injuries, traffic accidents, falling from height, blunt trauma, etc.

Some stomach perforation also has no specific cause and occurs spontaneously. In medicine, this is called "Ideopathic Spontaneous Perforation". No cause is found in some gastric perforations that cause death, even at autopsy.

What happens if the stomach is pierced?

The following symptoms can be seen when the stomach is pierced:

  • Extreme and sudden abdominal pain
  • Nausea and vomiting
  • Fever, sweating, palpitations
  • Shortness of breath

The puncture can happen suddenly and is dangerous. Half of the patients (50%) are young patients who have never had any previous complaints. Stomach ulcer in the other half or erosive gastritis There may be a history. In extremely intense or sudden stress situations, stomach perforation can be seen.

In the first stage of puncture, there is a very extreme and sudden contraction and pain in the stomach area. This is when stomach acid and its contents enter the abdominal cavity. (perinoteal cavity) indicates that it is flowing. Patients diagnosed at this stage are lucky and they overcome the disease with little risk because they receive early treatment.

After this stage (5-10 hours), most of the stomach contents are emptied into the abdominal cavity and diluted with the peritoneal fluid previously present there. (diluted). At this stage, a temporary and false relief is provided. However, the pain medications and serums given also provide the ground for the situation to progress insidiously and quietly.

12-24 hours after the event, the stomach contents in the abdominal cavity cause bacterial infection. (bacterial Peritonitis). At this stage, widespread and severe pain in the patient's abdomen, excessive contraction of the anterior abdominal wall muscles (due to peritoneal irritation The wooden abdomen, photo below), cross, nauseaVomiting, fever and shortness of breath occur. At this stage, despite the treatment, life-threatening comes to the fore. Most patients who cannot be diagnosed at this stage may face the risk of death.

A drawing of Mr. Hamilton Bailey following his abdominal breathing motion. In the classic case of perforated ulcer, abdominal movement is restricted or absent (wooden abdomen).
Bay Hamilton baileyAn illustration of the breathing movement following the abdominal region. In the classic case of perforated ulcer, abdominal movement is restricted or absent (wooden belly).

In general, we can say that; 60% of the patients are diagnosed only in the advanced stages, in 30% at the initial stage. 10% of patients can die without being diagnosed and treated.

Diagnosis of Gastric Puncture

Diagnosis can be made in a detailed abdominal examination performed by an experienced physician based on suspicion. There is some air with acid and food residues flowing from the stomach to the abdominal cavity. Outpatient direct abdominal radiographs (ADBG) or chest x-rays (PA Chest X-ray) this leaked air image can be seen in the lower part of the diaphragm in a crescent shape. This image is a typical clinical finding in terms of detecting the disease. (Inverted Crescent Finding).

adbg
PA ACG - Inverted Crescent Sign

In suspicious cases, if necessary, a probe is inserted from the nose to the stomach (Nasogastric NG catheter) and a film can be taken by giving air. However, blood tests and abdominal ultrasound can be done. Endoscopy can be applied in very suspicious cases.

Gastric Puncture Treatment

After the diagnosis, the patient is prepared for the operation without wasting time. The patient's condition is stabilized. It is fulfilled, especially if there is fluid loss. Broad spectrum antibiotics is started. After the puncture site is detected in surgery with stitches is closed and the abdominal cavity is rinsed with ample sterile isotonic fluids. (Peritoneal Lavage).

Gastric Puncture (Gastric Perfpration): Right sub-diaphragmatic free air seen in ADBG - inverted crescent finding
Stomach Perforation (Gastric Perfpration): Right sub-diaphragmatic free air - inverted crescent sign seen in ADBG (Op.Dr.Ertan BEYATLI, Genel Surgery MD, PhD)

There are many different approaches to surgery. The main purpose of all of them is the same. The puncture is closed, if there is an ulcer, it is removed. In order to prevent recurrent ulcers, gastric outlet is relaxed and acid-reducing interventions are made.(for example, gastrojejunostomy, antrectomy, vagectomy, etc.)

Gastric Perforation - Preoperative - Gastric perforation due to Peptic Ulcer. Edirne / 2013
Preoperative - Stomach perforation due to Peptic Ulcer. Edirne / 2013
Gastric Perforation - After Surgery - Perforation due to Peptic Ulcer. Edirne / 2013
Gastric Perforation - After Surgery - Perforation of the stomach due to Peptic Ulcer. Edirne / 2013

What is done after gastric puncture surgery?

After the operation, the patient is kept under observation in the hospital for 5-10 days. Probe inserted into the patient's abdomen (drain) and the tube inserted through the nose into the stomach (Nasogastric NG probe) It is taken in a controlled manner. Oral intake of food and water is started at the appropriate time (2-4 days) and discharged with anti-ulcer drugs to be given. After 2-3 weeks, if necessary, a control endoscopy examination is performed.

Gastric Perforation (Gastric Perfpration): Perforation focus detected during surgery. (Op.Dr.Ertan BEYATLI, General Surgery MD, PhD)
Gastric Perforation (Gastric Perfpration): Perforation focus detected during surgery. (Op.Dr.Ertan BEYATLI, General Surgery MD, PhD)

Is Stomach Perforation Dangerous?

As we have stated before, unfortunately 10% of patients die without being diagnosed and treated. 60% of the patients carry a high risk of life since the diagnosis is made in the advanced stages, and 30% of the patients have low risk due to early diagnosis.

Frequently Asked Questions - FAQ

Who are those who have gastric perforation?

Almost half of the patients are people who have never had stomach complaints before. The other half has a history of constant stress, stomach ulcers, recurrent gastritis and irritants.

Is there a risk of death in gastric perforation?

Cases can result in death if not treated at the right time.

Is there a stomach perforation due to stress?

Prolonged or repetitive extreme stress situations may increase the level of stomach acid and cause stomach perforation over time.

Is stomach puncture surgery a difficult operation?

Every surgery has its own risks. Morbidity and mortality rates are high in gastric puncture surgeries.

What is good for piercing in the stomach?

Gastric perforation is an acute abdomen and requires urgent surgical intervention. Therefore, it is useful to be examined without wasting time.

Which doctor to go to in gastric perforation?

In undiagnosed cases, he first applies to the emergency services. After the final diagnosis is made, general surgery death is made.

Can drugs cause stomach perforation?

Yes, irritating to the gastric mucosa. Some drugs can cause perforation of the stomach. For example, pain relievers, aspirin, apranax, magical anti-inflammatories.

Will gastric perforation show up in a blood test?

No. Stomach perforation is a clinical condition and can only be detected by clinical examination and a definitive diagnosis is made with the necessary radiological tests.

Does stomach perforation recur?

As long as the reasons that led to the previous gastric perforation continue, gastric perforation may be repeated.

Is the stomach pierced by alcohol?

In cases of excessive or multiple alcohol intake, stomach perforation may occur.

SUMMARY
• Disease: Puncture of the stomach, Perforation
• Causes: Stomach ulcer, trauma, during the procedure.
• Symptoms: Sudden abdominal pain, vomiting, fever, palpitations.
• Diagnosis: Examination, PA-ACG, ADBG, USG, CT, MR.
• Treatment: Emergency surgery. The death rate is high.

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