Perforated peptic ulcer is one of the most common but deadly gastrointestinal complications having high mortality rate. Peptic ulcer is a term used for ulcers in stomach and/or duodenum the first part of small intestine. An ulcer is open lesion or a sore in the mucus lining of gastrointestinal tract. This disease is more common in men as compared to women.
There are many attributing factors such as alcohol drinking and cigarette smoking, use of non steroidal anti inflammatory drugs, beside helicobacter pylori infection. This bacterium is known to cause inflammation and erosion in the mucus membrane of stomach and duodenum.The acids and digestive enzymes present in stomach and intestine further damages the erosion.
If the condition is not treated, the ulcer can penetrate deep down in the stomach or intestinal wall leading to perforation and spillage of the stomach content in the abdominal cavity. Perforation of peptic ulcer is an emergency. Early surgical repair and proper management of peritonitis are essential for a favorable outcome.
Sign And Symptoms Of Perforated Peptic Ulcer
The classical symptom of perforated peptic ulcer is sudden agonizing pain in abdomen. As peptic ulcer perforate the digestive enzymes and stomach acid leak into the abdominal cavity.This causes severe pain due to peritonitis. The pain is so intense that patient is often able to recollect the exact time and place it started. Pain is constant and spreads to the entire abdomen. Pain becomes worse from touch, movement, cough and sneeze. Patient breathes shallowly to avoid pain. The abdomen is markedly board like rigid.
Few hours after rupture, the abdomen will be swollen and there is complete absence of bowel sound. Patient appears pale and there is profuse sweating. His pulse is rapid. Over a period of time you may not be able to elicit pulse as it becomes extremely weak. The blood pressure may fall and difficult to measure. All these symptoms of shock are indication of critical condition of the patient.
Symptoms prior to perforation
Prior to perforation most patients have symptoms of peptic ulcer. They may be present for more than weeks and months. It may be pain between the breastbone and umbilicus. Pain is severe on empty stomach and may be relieved after eating food. It may become worse at nighttime. The stools are dark and tarry. This significant symptom indicated bleeding has begun from the ulcer. In some cases there is coffee ground vomiting.
What Causes Perforated Peptic Ulcer?
Today perforated peptic ulcer has become relatively rare; however, it is still considered a life threatening condition. There are several reasons that are associated with perforation of the peptic ulcer. Perforation of the ulcer usually occurs when the erosion present since many days has been constantly aggravated.
Certain factors which aggravate acid secretion are constant use of non steroidal anti inflammatory drugs (NSAID’s), steroids, alcohol consumption, smoking and H. pylori infection. All these factors have one thing in common. They increase the secretion of acid in the stomach lining.
At the same time H.pylori bacteria eat away the protective lining of the stomach. The digestive enzymes and acid can corrode the gastrointestinal lining and eventually cause perforation of the ulcer. Peptic ulcer can also perforate if there is severe trauma on the abdomen.
Treatment Of Perforated Peptic Ulcer
Perforated peptic ulcer is an emergency. It is one of the few dreaded complications of peptic ulcer. Patient presents with sudden pain in abdomen. He appears extremely sick and pale. X-ray of abdomen shows gas under the diaphragm. Sonography of abdomen and CT scan help in prompt diagnosis of the condition. Expeditious diagnosis and prompt treatment is the key for better outcome.
The treatment of most perforated peptic ulcer is surgical repair of the affected area. This may also depend on several factors such as age of the patient, any accompanying major medical illness, etc. During the surgery the perforated ulcer is repaired and the peritoneum is washed to prevent sepsis. Patient is also given antibiotics to kill H.pylori infection. Proton pump inhibitors are useful to suppress the secretion of acid content.
The doctor may opt for conservative management of ulcer if the leakage is very small. However, constant monitoring of the patient is essential till the ulcer is sealed.