Gastric perforation

If the lining of the stomach is damaged, this can lead to a Gastric perforation or to one Gastric perforation to lead. An open gastric perforation almost always represents a medical emergency.

What is a gastric perforation?

As part of a Gastric perforation (in medicine also as Gastric perforation called) breaks the stomach wall of an affected person.

A distinction can be made between the open and the covered gastric perforation; If there is an open gastric perforation, there is a risk, among other things, that the contents of the stomach will spill into the abdominal cavity. An open stomach perforation usually requires immediate, emergency medical measures. A covered gastric perforation is characterized by adhesions in the stomach that come into contact with neighboring organs.

In most cases, an open gastric perforation is associated with significantly more severe symptoms than a covered perforation; Common symptoms of open stomach perforation include pronounced and stabbing pain in the upper abdomen, which in individual cases can also radiate into the shoulders.

causes

Usually the Gastric perforation caused by gastric ulcers in those affected: gastric ulcers lead to damage to the gastric mucosa, which protects the stomach wall from gastric acid in healthy people. If this protection is omitted, the stomach wall can be attacked at the corresponding points; gastric perforation is a serious consequence.

Other causes that can be hidden behind a gastric perforation include, for example, injuries in the course of gastroscopy. Accidental ingestion of caustic substances can also result in a gastric perforation. Furthermore, a gastric perforation can be caused by long-term medication; various active substances have a tendency to attack the lining of the stomach, which increases the risk of a gastric perforation.

Medicines that can have a corresponding effect include cortisone (an active component that is used, for example, as an anti-inflammatory). In very rare cases, a gastric rupture can also be the result of cancer that affects the stomach.

Symptoms, ailments & signs

An open gastric perforation typically manifests itself as severe, sharp pain in the middle of the upper abdomen. The pain can radiate into the chest and shoulder region. Most of the time, the symptoms appear suddenly - but in individual cases they are preceded by a long medical history. If the stomach contents get into the abdominal cavity, there is a risk of peritonitis.

The pain spreads in the abdomen, which results in a relieving posture. The hardening of the abdominal wall is also characteristic, accompanied by severe pressure pain and an increasing feeling of illness. With a covered perforation, symptoms are less pronounced.

Mostly, slight pain is noticed, which increases in intensity over the course of several days. An open gastric perforation does not go away on its own. It is a medical emergency that requires medical attention. Otherwise the symptoms will increase and there is an acute danger to the patient's life.

If left untreated, a covered gastric breakthrough also takes a difficult course, with increasing pain and a growing feeling of illness, which significantly impairs well-being. With early treatment, the symptoms will disappear after a few days. The feeling of illness may persist for one to two weeks, depending on the severity of the perforation.

Diagnosis & course

The suspected diagnosis Gastric perforation is initially possible for a doctor due to the typical, stabbing pain of a patient; As a rule, information relating to the individual medical history and initial symptoms are also included in a corresponding suspected diagnosis. The suspicion of a gastric perforation can be checked in the next step with the help of the X-ray; if free air can be seen in the abdominal cavity, this indicates a gastric perforation.

While a covered gastric perforation is often comparatively mild and has good chances of recovery, various complications can arise in the context of an open gastric perforation: For example, penetration of the stomach contents into the abdominal cavity can cause life-threatening peritonitis; A corresponding inflammation is often associated with widespread abdominal pain and a hardened abdominal wall.

Complications

Life-threatening complications can occur as a result of a gastric perforation. In addition to the severe pain, a breakthrough can cause peritonitis, which can lead to fever, constipation and possibly even an intestinal obstruction. A septic shock with blood pressure fluctuations, breathing disorders and circulatory failure can rarely occur. In severe cases, peritonitis leads to death.

Another possible complication is blood poisoning. Also associated with pain and fever symptoms, sepsis can lead to multiple organ failure and even impair nerve and brain function. If the brain is affected, memory and learning can be permanently impaired. If the nervous system is affected, symptoms of paralysis and chronic pain can occur.

With a covered perforation, such as occurs with adhesions, fistula formation with neighboring organs can occur. As a result, severe organ damage can occur. If the gastric perforation is treated in good time, there are usually no further complications.

Sometimes, however, the person affected has to change their diet. In addition, the prescribed drugs can cause side effects and allergic reactions. In order to avoid complications, a doctor should be consulted immediately if a gastric perforation is suspected.

When should you go to the doctor?

Sudden pain in the upper abdomen, pain to touch or hardening of the abdominal wall are signs of health problems. A doctor's visit is necessary so that the cause of the symptoms can be determined. A gastric rupture is a medical emergency that must be treated as quickly as possible. If the symptoms that occur rapidly increase in intensity in a short period of time, an ambulance service is required. Until it arrives, first aid measures are to be provided by those present to ensure the survival of the person concerned.

If the feeling of illness increases, general malaise and internal weakness, a doctor is needed. If you experience cramps, bleeding, vomiting, or nausea, you should consult a doctor. If you have a fever, abnormal heart rhythm, loss of appetite or problems with the digestive tract, you should see a doctor for a check-up. If the person concerned takes a gentle posture, the need for sleep increases and he suffers from fatigue and exhaustion, a doctor should be consulted.

If the usual level of performance drops, professional or everyday obligations can no longer be fulfilled or sleep disorders set in, a doctor's visit is required. A loss of well-being, an increased body temperature and inner restlessness are signs of an irregularity. If the symptoms persist for several days or if they gradually increase in intensity, a doctor is required.

Treatment & Therapy

Medical treatment of a Gastric perforation depends, among other things, on the shape of the perforation and the individual complications that arise in the course of the disease.

If an open gastric perforation has to be treated with emergency medicine, surgical intervention is inevitable in most cases; In the course of an operation that is taking place, the perforation on the stomach wall is usually closed first. Subsequent flushing of the abdominal cavity frees the stomach from stomach contents that were able to empty out of the stomach in the course of the gastric perforation - this type of rinsing after an open gastric perforation helps to reduce the risk of peritonitis and the progression of an inflammation that has already occurred to prevent.

The surgical interventions necessary for an open gastric perforation are usually carried out under general anesthesia and minimally invasive (the abdominal wall does not have to be opened over a large area with an incision). If someone with an open gastric perforation has severe peritonitis, this is often observed by intensive care. A covered gastric perforation does not require surgical intervention in many cases; occasionally the stomach is relieved by a nasogastric tube.

Outlook & forecast

An open gastric perforation is life threatening. If there is no timely treatment in the form of an operation, the patient faces death. Early intervention is always preferable. 24 hours after the breakthrough, the probability of survival is only 50 percent. It decreases with every additional hour of waiting. The general condition and age of the patient are also relevant for healing. Certain pre-existing conditions can reduce the likelihood of recovery.

If the stomach contents get into the abdominal cavity, the chances of recovery deteriorate considerably. Inflammation can develop. A covered gastric perforation results in a significantly better prognosis. Here there are only connections to other organs. The doctor decides on the therapy based on an X-ray. Surgical intervention is not always necessary. Conservative therapies sometimes also promise a cure. A covered gastric perforation is usually not a life-threatening situation.

Successful acute treatment does not automatically lead to a full recovery. Some patients can no longer consume all the foods they are used to, which results in small to large restrictions in everyday life. The extent to which there is intolerance after gastric surgery cannot be predicted.

prevention

There a Gastric perforation In most cases caused by gastric ulcers, early treatment of such ulcers can prevent perforation of the gastric wall. If, for example, long-term use of medication has already led to stomach damage in an individual case, a doctor's advice regarding alternative preparations can help prevent a gastric perforation.

Aftercare

Follow-up care for a gastric perforation depends on the severity of the disease. In milder cases, regular examinations are sufficient to determine whether the healing process is proceeding as expected. Physical exertion should be avoided; sometimes those affected depend on the help of family and friends in everyday life. The usual routine should be slowly resumed in order to spare the bruised stomach, a change in diet with light, low-acid food is recommended.

Each patient should also discuss with the doctor treating them what should be considered when changing their diet. In addition, symptoms such as frequent heartburn, stabbing stomach pains or vomiting blood must be linked to the previous history and clarified in the future. In more severe cases, closely timed controls are necessary in order to avert further complications in good time.

You can do that yourself

People with a gastric perforation face a medical emergency. Affected people behave correctly if they immediately call an emergency doctor or observe what is happening. A sudden physical breakdown occurs when a stomach ruptures. In some patients, this acute state has already emerged over a long period of time due to various symptoms. Therefore, in order to avoid gastric perforation, a doctor should be consulted in good time.

If the emergency arises, first aid care is necessary in the event of organ failure so that the patient does not die prematurely. Avoid, whenever possible, excitement, well-intentioned advice and discussion. The affected person should refrain from unnecessary movements until the emergency doctor arrives and try to remain calm despite the severe pain. Even breathing is necessary so that the organism is supplied with sufficient oxygen.

In the event of unconsciousness, bystanders are obliged to check that their breathing is safe. If it fails, artificial respiration using the mouth-to-mouth technique must be initiated. Due to the complaints, the patient automatically takes a relieving posture. This is a natural human reaction that ensures survival. Immediate surgical intervention is necessary to prevent further illnesses or inflammation. There are no alternative options for a gastric perforation.