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Gastric perforation is extremely rare due to the strong muscles of the stomach wall. Nevertheless, they are among the most common complications of gastric ulcers and gastric carcinomas.
What is gastric perforation?
A gastric perforation creates openings in the stomach wall. This is made possible when the gastric mucosa, which protects the outer wall from stomach acid, becomes permeable. The severe case is an open perforation, in which the contents of the stomach leak into the abdomen and cause inflammation of the peritoneum .
Fast action is not necessary because of the gastric perforation itself, but because of the consequences. With a covered perforation of the stomach, fistulas grow , which connect to other organs through the stomach wall. This means that there is no gap in the stomach wall through which the contents can escape. Medicine refers to gastric perforation as gastric perforation.
causes
Gastric perforation in infants often occurs spontaneously, although science can only speculate as to the causes. In adulthood, with a few exceptions, a perforation is always the result of a stomach disease. The most common causes include gastric ulcers and carcinomas. The predominantly acidic environment attacks the stomach lining and works its way up to the acid-sensitive stomach wall – it becomes thinner and eventually breaks open.Cortisone and, above all, painkillers can also destroy the protective gastric mucosa and thus trigger a gastric perforation. Blunt external force can also cause damage to the stomach wall, but this must be very severe. In isolated cases, there are also injuries during the gastroscopy . In very rare cases, a congenital diaphragmatic hernia is responsible for gastric perforation. This is a gap in the diaphragm that allows organs to move from the abdomen to the chest.
symptoms and course
Typical symptoms of a gastric perforation:
Covered gastric perforations, in which adhesions and fistula formation take place, proceed largely without typical pain or only with mild symptoms. An open gastric perforation suddenly causes severe pain, which becomes more intense again after a phase that subsides. The reason for this is not the perforation of the stomach itself, but the inflammation in the abdomen it causes.
Those affected reflexively adopt a relieving posture and the abdominal wall is hard. The reason for this is a spasm of the abdominal muscles. The strong overinflation is also noticed with a simultaneous feeling that the stomach area is contracting. As with all inflammations, fever and malaise are also typical symptoms. If left untreated, an open gastric perforation also results in a state of shock due to blood poisoning with subsequent circulatory failure due to the spread of gastric acid and other contents ; this within a few hours.
Diagnose
In the case of acute abdominal pain, the doctor feels the abdomen and tries to localize the organ causing the pain. If the abdominal wall is also hard and the pain is severe and sudden, this indicates a gastric perforation. X- rays or computed tomography are used to obtain a reliable diagnosis . With an open stomach perforation, there is air in the abdomen, which can be seen in pictures. If the contents of the stomach have escaped, the inflammatory values in the blood are increased. Fistulas in the covered gastric perforation can be detected by gastroscopy.
treatment and therapy
In the case of covered perforations in the stomach, an operation is no longer necessary in many cases and is treated with medication. Relief of the stomach is important in conservative therapy, which is why feeding takes place first via a gastric tube and then a healing diet is prescribed that avoids acid-stimulating foods. Open gastric perforation, on the other hand, is a medical emergency. Once the diagnosis is clear, surgery must be performed immediately.
The operation is now minimally invasive, i.e. using the buttonhole method. A large incision is only necessary if the exit point cannot be precisely located. To do this, air is pumped into the abdominal cavity in order to raise the abdominal wall slightly. The primary goal is to close the opening with a suture so that no more stomach acid can get into the abdominal cavity. Part of the stomach wall is often removed from the affected area because the poor healing of the wound encourages it to rupture again.
The abdomen must then be flushed to remove the contents that have escaped from the stomach. This is to prevent the inflammation from spreading and serious complications as a result. In the case of advanced inflammation, postoperative intensive medical care is required because there is still a risk of blood poisoning.
After the operation, gastric acid production should be reduced to a large extent, which is why feeding is done via a gastric tube. A change in diet and lifestyle contributes significantly to healing. Alcohol , nicotine , and hot spices stimulate both acid production and bacterial resettlement. Painkillers that attack the gastric mucosa should only be given if there is an absolute urgency.
prevention
In principle, it is important to minimize the risks for the underlying diseases that trigger them. Diet plays an important role in this. Increased meat consumption promotes the development of stomach ulcers. Sausage products and meat processed with curing salt also promote hyperacidity, which is responsible for the proliferation of helicobacter bacteria .Around half of the world’s population carries these bacteria, but with the help of the immune system they can keep the number at a level that is not harmful to health. Stress and nicotine are also among the risk-increasing factors.
Hello and welcome to my Health Guide & Encyclopedia! My name is Dorothy Farrar, and I'm the founder and main author of this platform.
My passion for health and wellness started at a young age when I became interested in the connection between the food we eat and the way we feel. This fascination led me to study nutrition and dietetics in college, where I learned about the importance of a balanced diet and the impact of various nutrients on the body.