Perforated Stomach Ulcer

Peptic ulcers are open lesions or sores that appear on the walls of the stomach and duodenum. Sometimes esophageal ulcers are also included in this category. While ulcers on the stomach wall are termed gastric ulcers, those in the esophagus are esophageal ulcers. Duodenal ulcers are located on the walls of the duodenum, which is the first part of the small intestine.

Peptic ulcers are commonly referred to as stomach ulcers. These ulcers can be caused by various factors, but the most prominent among them are helicobacter pylori infection and regular intake of certain drugs. If left untreated, stomach ulcers may start bleeding or cause perforation of the locations, where they are found. If the ulcer is located on the stomach wall, it will gradually cause perforation of the stomach wall. The same applies to duodenal and esophageal ulcers. 

What is a Perforated Stomach Ulcer?

Without proper treatment, stomach ulcers may cause complications, like bleeding or perforation. As the lesion or ulcer on the stomach or duodenal wall worsens, it damages the muscles and the blood vessels. Damage to the blood vessels results in bleeding ulcers. If the blood vessels are small, the rate of bleeding would be low. Small amounts of blood may ooze out to the gastrointestinal tract, causing anemia in the long run. Damage to major blood vessels can be an emergency condition that requires immediate medical attention. While an endoscopy is sufficient to stop such bleeding, surgery may be required in some cases. 

Another major complication is perforation. An untreated ulcer may slowly eat away the stomach muscles, and create a perforation or a hole. This causes spilling of food and digestive juices into the abdominal cavity. If the ulcer is caused by helicobacter pylori bacteria, then these microorganisms too enter the abdominal cavity. As the content of the stomach or duodenum spills to the peritoneum, through the perforated ulcer; the cavity gets inflamed and infected (peritonitis). This is an emergency condition that requires immediate medical treatment. 

Symptoms and Treatment

The most obvious among perforated stomach ulcer symptoms is sharp and severe abdominal pain that occurs all of a sudden. Even slight body movements can worsen the pain. Some may experience severe epigastric pain located anywhere between the navel and the lower part of the breast bone. 

Perforated ulcer symptoms and their severity depend on factors, like the degree of perforation, amount of gastric or duodenal contents that is spilled into the cavity, and presence of bacteria in the contents. The affected person may also experience rapid heartbeat, hypotension, and decrease in urine output. Severe cases may cause shock too. Some people may also experience heartburn, loss of appetite, nausea, and vomiting. It has been observed that the severity of these symptoms is minimal in elderly patients. 

Diagnosis is usually done through X-rays that are taken in an upright position. Computed tomography is also used to detect the condition. Surgery is the most common treatment for a perforated stomach ulcer. Usually, the perforated part is patched up, followed by peritoneal lavage (washing of the peritoneal cavity). The patient is administered with antiulcer drugs. In most cases, any of the remedial surgeries, like vagotomy, pyloroplasty, antrectomy, and partial gastrectomy, may also be done. As there are high chances of recurrence of stomach ulcers, remedial surgeries are recommended by health experts, as a part of treatment. Peptic ulcer surgeries are usually avoided, unless complications, like perforation or heavy bleeding occur. 

In short, perforated stomach ulcers have to be treated at the earliest, so as to avoid further complications. It is always better to treat such ulcers at the very onset, so that they do not lead to bleeding or perforation.