A gastric perforation is a medical emergency in which a pathological perforation of the stomach wall occurs. The disease is often caused by a stomach ulcer. Read here which symptoms occur, which causes are still possible and how the treatment is carried out!
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Quick overview: Frequently asked questions and answers
What is gastric perforation? A gastric perforation occurs when an abnormal opening occurs in the stomach wall. In severe cases, this results in stomach contents leaking into the abdominal cavity. Gastric perforation often occurs due to a stomach ulcer.
How do you notice a stomach perforation? Typical symptoms of an open stomach perforation are acute, very severe abdominal pain, which is localized above the navel. The symptoms can radiate into the shoulders and back.
How dangerous is a perforated stomach? A stomach perforation is always an emergency and requires immediate medical attention. If left untreated, life-threatening peritonitis can develop.
Article content at a glance:
Stomach ulcer: recognizing symptoms and warning signs
What is gastric perforation?
A gastric perforation causes a hole or tear in the stomach wall. Medical experts differentiate between two different forms:
open perforation: Open stomach perforation is a medical emergency. There is a risk that stomach contents will end up in the abdominal cavity.
covered perforation: A covered gastric perforation is characterized by adhesions (fistulas) in the stomach, which create connections to surrounding organs through the stomach wall. The break point is sealed by neighboring intestines, preventing any contents from leaking out.
Danger! Gastric perforation is an emergency
An open stomach perforation requires immediate medical attention. In acute cases, those affected should neither eat nor drink anything.
Symptoms: This is how a stomach perforation becomes noticeable
An open gastric perforation causes an acute abdomen. This refers to sudden, severe abdominal pain (destructive pain). The symptoms are often felt in the upper abdomen or stomach area and can radiate to the shoulders and back.
The pain often comes on suddenly. However, it also happens that they have a longer history of illness. For some of those affected, the symptoms are less severe and/or subside after hours, only to become more pronounced again after a short time.
How does a covered breakthrough manifest itself?
An open perforation is usually accompanied by more obvious symptoms than a covered gastric perforation. The latter can also be noticeable through mild pain, loss of appetite and a general feeling of illness. The symptoms often increase in intensity within a few days.
Perforation of the stomach can lead to life-threatening peritonitis
If stomach contents get into the abdominal cavity, life-threatening peritonitis can develop. The peritoneum is a thin layer of tissue that lines and protects the interior of the abdomen.
If it becomes inflamed, pain occurs throughout the entire abdominal cavity. Patients’ abdominal wall can be very hard and sensitive to pressure. Those affected usually adopt a protective posture. Other symptoms include:
Over time, shock, including circulatory collapse, can develop. This is shown by symptoms such as paleness, cold, sweaty skin, restlessness and a rapid heartbeat with a low pulse.
Peptic ulcer is a common cause of stomach perforation
A common cause of stomach perforation is a stomach ulcer. This is a deep wound in the stomach lining. It forms when the protective factors in the stomach lining fail to combat aggressive stomach acid. A stomach ulcer is often the result of an inflammation of the gastric mucosa.
A stomach ulcer is often caused by years of taking certain painkillers. These include, in particular, agents from the group of non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen or acetylsalicylic acid.
But an infection with the bacterium Helicobacter pylori can also damage the lining of the stomach and cause complications such as an ulcer.
Rare causes of a stomach perforation are, for example
Injuries to the stomach caused by gastroscopy (gastroscopy) or from the outside, for example by a knife stab in the stomach
Stomach cancer (stomach carcinoma)
Chemical burns in the stomach area
swallowed foreign bodies
Stomach ulcer: Have symptoms clarified early
Stomach ulcers, together with duodenal ulcers, are among the so-called peptic ulcer diseases. In Germany, around 30,000 to 40,000 people are affected by these gastrointestinal diseases every year.
A stomach ulcer initially causes symptoms such as diffuse upper abdominal pain, nausea or a feeling of fullness. In general, however, they rarely lead to a stomach perforation. Ulcers are more likely to cause bleeding in the stomach. Signs of this include vomiting blood or black stools (tarry stools). Those affected should definitely have such complaints clarified at an early stage.
This is how a stomach perforation is diagnosed
Typically, gastric perforation is a sudden event that requires rapid hospital treatment.
First, an anamnesis is taken, which, among other things, clarifies how long the symptoms have existed and whether there are any previous illnesses.
Suspicion of the disease can be confirmed by X-rays: If the images show that there is air in the abdominal cavity, this suggests a stomach perforation. If necessary, a computed tomography (CT) scan is performed to confirm the suspicion.
How is stomach perforation treated?
The exact treatment for a stomach perforation depends on its form, cause and severity. An open stomach perforation always requires rapid emergency medical care. Therapy consists of a surgical procedure (laparotomy), in which the perforation in the stomach wall is closed.
If stomach contents have escaped, the abdominal cavity is flushed to reduce the risk of peritonitis or to stop the progression of existing inflammation. Treatment often has to take place in the intensive care unit.
If an ulcer is the cause, it is operated on. In severe cases, the doctor has to remove parts of the stomach. If the stomach perforation is caused by Helicobacter pylori, various medications are used after the operation to eliminate the bacteria.
Treatment of a covered gastric perforation
In the case of a covered gastric perforation, surgery is not always necessary. Under certain circumstances, conservative therapy with medication can be considered. If necessary, a gastric tube will also be placed to relieve the pressure on the stomach and make it easier for gastric juice to flow out.
Course and prognosis: How dangerous is a stomach perforation?
The prognosis or chance of survival depends largely on how quickly the stomach perforation is treated or operated on. But the size of the perforation and the state of health of the person affected also influence the course of the disease.
If gastric perforation is recognized and treated early, the prognosis is generally good. If appropriate therapy is not provided, the breakthrough will most likely lead to death.
It is therefore important to take the first signs of a stomach perforation seriously and seek medical treatment early.
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