Perforated ulcer

Perforated Ulcer

A perforated ulcer is a critical condition characterized by a complete breach through the wall of the stomach, duodenum, or another segment of the gastrointestinal tract due to an untreated ulcer. This perforation allows the contents of the stomach or intestines, including acids and partially digested food, to spill into the peritoneal cavity, the sterile area surrounding the abdominal organs. This leakage can lead to peritonitis, an acute and potentially life-threatening inflammation of the abdominal cavity's lining.

Causes

Perforated ulcers are primarily caused by the progression of untreated peptic ulcers, which may result from:

• Helicobacter pylori Infection: A bacterial infection that can erode the protective lining of the stomach and intestines.
• Chronic Use of NSAIDs: Nonsteroidal anti-inflammatory drugs can weaken the stomach's mucosal lining, making it more susceptible to ulcers.
• Other Factors: Excessive alcohol consumption, smoking, and stress can also contribute to ulcer formation and increase the risk of perforation.

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Illustration of a gastrointestinal ulcer leading to perforation.

Symptoms

The onset of a perforated ulcer is usually sudden and severe, with symptoms including:

• Sharp, intense abdominal pain that may radiate to the shoulder.
• A rigid, board-like abdomen that is tender to touch.
• Nausea and vomiting.
• Fever and chills.
• A rapid heartbeat and breathing.

Diagnosis

Prompt diagnosis is crucial for managing a perforated ulcer. Diagnostic approaches include:

• Physical Examination: Assessing symptoms and checking for signs of abdominal rigidity and pain.
• Imaging Tests: Abdominal X-rays or CT scans to detect air leaking from the stomach into the abdominal cavity.
• Blood Tests: To check for signs of infection or inflammation indicative of peritonitis.

Treatment

Treatment for a perforated ulcer usually involves emergency surgical intervention to repair the perforation and prevent further leakage. Options include:

• Surgical Repair: Closing the perforation through suturing or patching the ulcer site.
• Antibiotics: To treat or prevent infection resulting from bacterial contamination of the peritoneal cavity.
• Proton Pump Inhibitors (PPIs): To reduce stomach acid production and facilitate healing.

Potential Complications

Without prompt treatment, a perforated ulcer can lead to severe complications, such as:

• Peritonitis: Severe infection of the abdominal cavity, requiring urgent medical intervention.
• Sepsis: A life-threatening response to infection that can lead to organ failure and death.
• Abscess Formation: Localized collections of pus due to the infection in the abdominal cavity.

Prevention

Preventative measures for perforated ulcers focus on addressing the underlying causes of peptic ulcers, including:

• Treating Helicobacter pylori infections promptly.
• Using NSAIDs judiciously and under medical supervision.
• Adopting lifestyle changes to reduce ulcer risk, such as limiting alcohol consumption and quitting smoking.

External Links

• Mayo Clinic - Peptic Ulcer
• National Institute of Diabetes and Digestive and Kidney Diseases - Peptic Ulcers

References

• Gastrointestinal Surgery: Management of Complex Perioperative Complications by Springer Nature.
• Modern Management of Perforated Peptic Ulcer by World Journal of Emergency Surgery.

Perforated ulcer Resources
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