Treatment of Perforated Peptic Ulcer

About the disease

Peptic ulcer is the condition whereby sores develop in the stomach lining. These sores can also develop in esophagus and part of the small intestine, closest to the stomach. Such ulcerations are caused by the erosive process in upper digestive tract tissues. The most common cause of such erosion is a bacterial infection. When a person contracts bacterial infection, the stomach is unable to neutralize the stomach acid as efficiently as it does when the person is healthy. As a result, the acid starts to build up in the tissues and the person develops ulcer.

There are many causes how the person can contract the bacterial infection. The most common cause is food or water poisoning. It is more common in developing regions, where the quality of food and water can be poor, that's why the risk of contracting an infection is higher. People with with other digestive problems can be prone to development of bacterial infections. Viruses can lead to the same symptoms as well. It is important to wash hands before consuming the food and avoid drinking tap water in regions where it is not purified. It is also important not to consume products behind their shelf life. Proper diet and also personal hygiene are important in keeping the digestive system healthy.

Nonetheless, people rarely develop ulcer as a result of bacterial infection. If the person had chronic food poisoning and consumes low-quality products and water on a daily basis, the risk of developing peptic ulcer becomes higher. In severe cases the person may develop perforated peptic ulcer, when the ulcer starts to penetrate through the tissues where it originates. When it happens, the ulcer can lead to development of a hole in either stomach or intestinal wall. As a result, the person feels acute abdominal pain. The pain appears suddenly, just when the peptic ulcer becomes perforated. It is usually described as acute and intense. It is a medical emergency and a person needs to be taken to the hospital immediately to avoid complications.

Symptoms

• Acute pain in the upper abdomen
• Pain intensifies with slightest movement
• Pain can radiate to other parts of the abdomen as well
• Tenderness of the stomach
• Abdominal swelling
• Dizziness
• Nausea
• Vomiting

Diagnosis

• During a general examination the doctor will palpate the abdomen slightly to determine the source of pain. If a person has perforated peptic ulcer, he/she will reflexively stiffen the abdominal muscles due to the pain.
• The doctor will ask if the person had an infection lately, if he/she drinks too much or smokes, as these bad habits can also lead to development of perforated peptic ulcer.
• Upper endoscopy is needed to examine the abdominal tissues and determine if the peptic ulcer perforated. It is also needed to determine the exact location of the peptic ulcer. A person needs to swallow barium and then the doctor will examine the stomach with special tube.
• A blood test may be needed to determine which infection caused development of perforated peptic ulcer.

Treatment

• Conservative treatment uses antibiotics and also acid blockers to fight the infection if it was the underlying cause of perforated peptic ulcer and also to reduce the acid production in the stomach.
• Open or laparoscopic surgery is used in case a person has acute pain and perforation. The surgery aims to remove the digestive enzymes that spilled from the stomach to other tissues and also stitch the hole caused by perforated peptic ulcer.
• After treatment a person needs to follow special diet and also avoid eating product that can increase production of acid. It is important to avoid drinking alcohol and smoking during the recovery time and, ideally, afterwards as well to avoid recurrence.

Authors: Dr. Vadim Zhiliuk, Dr. Sergey Pashchenko