Gastric perforation
definition
A gastric perforation is called a gastric perforation in medical jargon. It comes to one sudden rupture of the stomach wall and a hole is created. The stomach contents enter the free abdominal cavity through this hole. It comes to one Irritation of the peritoneum from the corrosive stomach acid and one develops rapidly Peritonitis (Peritonitis).
The most common cause of a gastric rupture is stomach ulcer. In addition to the open breakthrough (open perforation), there is also a covered perforation. This also suddenly creates a hole in the stomach wall, but the hole is covered by other structures in the abdomen so that this type of breakthrough is less acute. A gastric perforation is a life-threatening disease that usually requires immediate surgery and intensive medical care.
causes
The most common cause of gastric perforation is this Gastric ulcer. In the case of a gastric ulcer, inflammatory damage to the gastric mucosa occurs.This is usually caused by an excess of stomach acid and a lack of a protective mucous film for the mucous membrane. The inner stomach wall is attacked by the stomach acid and becomes thinner and thinner. This increases the risk of a rupture through the stomach wall.
Many stomach ulcers are caused by the use of certain pain relievers and anti-inflammatories (NSAIDs) without the additional intake of a stomach protection like Pantozol®.
This is a less common cause of a gastric perforation Gastric cancer (Stomach cancer). The cancer eats its way into the stomach wall, so to speak, leading to a thinning of the wall - similar to the ulcer - so that the risk of a stomach rupture increases.
In rarer cases, a gastric perforation occurs as part of a gastroscopy on. The device with which the gastroscopy is performed (gastroscope) accidentally punctures the stomach wall. Also pronounced acid burns in the area of the stomach can lead to a breakthrough.
Is alcohol a cause of a gastric rupture?
Alcohol in itself is not a direct trigger for a gastric rupture. However, alcohol is considered more likely Risk factor for developing gastric cancer (Gastric cancer). The development of a stomach ulcer can also be promoted by regular consumption of high-percentage alcohol. In this respect, alcohol can indirectly be viewed as a risk factor for the development of a gastric perforation.
diagnosis
A gastric perforation is usually a very acute event that is usually accompanied by severe pain. This leads most of those affected quickly to the attending physician or to an emergency room.
First, here is the anamnese (Doctor-patient conversation) important for diagnosis. The doctor will ask how long the pain has been going on and if it started suddenly. The question of previous illnesses is also important, in particular whether a stomach ulcer or stomach cancer is known. You can also ask whether you have had stomach pain before.
If there is a suspicion of a gastric perforation, a X-ray image prepared. If a gastric perforation has occurred, so-called free air can be seen in the X-ray image in most cases. This is initially - together with the anamnesis - the surest indication of the presence of a gastric perforation. The diagnosis can only be made with certainty when an operation is carried out.
What are the signs of a gastric perforation?
Since a gastric perforation usually arises on the basis of a gastric ulcer, the symptoms that occur in the context of such an ulcer are in principle to be assessed as a sign / omen for a gastric perforation. It should be noted, however, that gastric perforation is a rare complication; So there are a lot of stomach ulcers that never happen.
Symptoms of a stomach ulcer include Pain in the upper abdomen, the particular shortly after eating occur and subside when sober. A feeling of pressure in the upper abdomen, a feeling of fullness, loss of appetite as well as nausea and vomiting can also occur.
If a gastric ulcer is suspected, the treating doctor should be consulted. The doctor prescribes medication, which usually causes the ulcer to heal.
There are no direct signs that occur in the days or hours before a gastric perforation. Perhaps the pain that many of you have already experienced with the ulcer will increase again. In most cases it occurs from the moment the stomach ruptures sudden severe pain in the upper abdomen. The pain can extend into the shoulder. In addition, it can increase after a short time fever, significant deterioration in general condition and possibly severe circulatory problems come. If you have any of these symptoms, you should call the emergency services immediately. The time from the onset of symptoms to the operation is crucial for the prognosis.
Concomitant symptoms
The accompanying symptoms are already described above. Next to the severe pain can it to fever and the Development of shock With very low blood pressure and rapid pulse come. The symptoms arise primarily from the rapidly developing inflammation of the peritoneum (peritonitis) after the peritoneum has come into contact with the acidic contents of the stomach.
Pain
In most cases, pain is Main symptom a gastric perforation. The pain is usually sudden and severe. There may be a radiation in the back or shoulder.
treatment
Treatment of a gastric perforation is immediate in most cases surgery. Either the hole in the stomach is over-sewn or a part of the stomach has to be removed if the hole is too big to over-sew.
Can a gastric perforation be fatal?
As mentioned above, a gastric perforation is one life-threatening illness that can be fatal. The prognosis largely depends on how quickly the disease is treated surgically. With every hour that passes between the onset of symptoms and the operation, mortality increases. If there are more than 24 hours between the onset of symptoms and the operation, the mortality rate is over 50%.
cure
The healing of a gastric perforation can in most cases only through surgery can be achieved. The triggering factor, such as an ulcer, is often removed as part of the operation.
Whether a gastric perforation heals without consequences and what the prognosis is depends heavily on how much time has passed between the perforation and the operation. If peritonitis develops, intensive medical treatment may be necessary. Then the prognosis depends on the general condition of the patient and the previous illnesses. In the advanced stage (no treatment of the gastric perforation up to 24 hours after onset) the disease can be fatal in over 50% of cases.
What are the consequences of a gastric perforation?
In the acute stage, a gastric perforation leads to the contents of the stomach leaking into the abdominal cavity. This quickly leads to peritonitis. Rapid surgical therapy is therefore essential.
If the operative therapy is successful, the Slow diet with light, low-fat food respectively. Even if a partial removal of the stomach was necessary, the diet continues. Diet may need to be changed after the procedure. This depends on how the person concerned tolerates the food.
Otherwise exist after a successful operation in many cases no restrictions more.
