Acute perforation of peptic ulcer

　　Acute perforation is a serious complication of gastric and duodenal ulcers, a common surgical acute abdomen. It has an acute onset, severe condition, and rapid changes, requiring emergency treatment. If not treated properly, it can be life-threatening. Then, what are the causes of this disease?

　　1. Excessive mental tension or fatigue can increase vagal nerve activity, worsening the ulcer and causing perforation.

　　2. Overeating increases intragastric pressure, promoting the perforation of gastric ulcers.

　　3. The use of non-steroidal anti-inflammatory drugs is closely related to this condition.

　　4. The use of immunosuppressants, especially the use of hormone treatment in organ transplant patients, can promote the occurrence of perforation.

　　5. Other factors include trauma, large-area burns, and multi-organ failure, etc.

　　Acute perforation of peptic ulcer is one of the serious complications of peptic ulcer disease. The onset of the disease is acute, and if not treated in time, it may pose a threat to life. The following are common complications caused by acute perforation of peptic ulcer.

　　1. Shock

　　Severe chemical stimulation after perforation can cause shock symptoms. The patient may appear restless, shallow breathing, rapid pulse, unstable blood pressure, and other manifestations. As the degree of abdominal pain decreases, the situation may become stable. Subsequently, as bacterial peritonitis worsens, the condition may deteriorate again, and severe cases may develop into septic (toxic) shock.

　　2. Acute peritonitis

　　The whole abdominal muscle is tense like a board, with significant tenderness, resistance to palpation, and rebound pain can be elicited in the whole abdomen. Laboratory examination: leukocyte count increases. Generally, in cases of acute perforation, the leukocyte count is between 15,000 and 20,000/mm3, with an increase in neutrophils; hemoglobin and red blood cell count also increase due to varying degrees of dehydration. Puncture of the abdominal cavity for exploration, microscopic examination of the extracted fluid, if full field of leukocytes or pus cells are seen, it indicates inflammatory ascites, which is evidence of peritonitis. The content of ammonia can also be measured, if it exceeds 3μg/ml, it indicates gastrointestinal perforation.

　　Most patients have a history of peptic ulcer disease and the ulcer symptoms have intensified in the past few days. Perforation often occurs suddenly at night on an empty stomach or after a meal, with typical symptoms of sudden severe epigastric pain, cutting-like, which can radiate to the shoulder and quickly spread to the entire abdomen. The patient often appears pale, cold sweat, cold extremities, thin pulse, and shock symptoms, accompanied by nausea and vomiting. Due to secondary bacterial peritonitis, abdominal pain can worsen.

　　Signs: The patient assumes an强迫体位, has shallow breathing, and often has a high fever. General abdominal tenderness, rebound pain, the most obvious in the upper abdomen, presenting as a 'board-like abdomen'. Percussion of the liver dullness border is reduced or disappears, and there may be mobile dullness. Auscultation of bowel sounds is absent or significantly decreased.

　　The main prevention of acute perforation of peptic ulcer is to pay attention to scientific diet, especially for those with gastric disease, do not drink alcohol to avoid aggravating the condition or triggering the disease. If sudden upper abdominal pain occurs, it should be sent to the hospital emergency room as soon as possible. Do not abuse analgesics before diagnosis, and do not eat, drink, or apply heat compresses to avoid masking and aggravating the condition. In addition, having a regular lifestyle, combining work and rest, avoiding excessive tension and worry, and other factors are all important for patients with peptic ulcer disease.

　　Acute perforation of peptic ulcer is a common surgical acute abdomen with an acute onset. The typical symptoms are sudden severe epigastric pain, cutting-like, and generally for the diagnosis of this disease, it is usually necessary to perform the following examinations.

　　1. Laboratory examination

　　Leukocyte count increases, and serum amylase slightly increases.

　　2. Abdominal puncture or lavage

　　Diagnosis can be made when extracting fluid containing bile or food residue.

　　3. Standing abdominal X-ray examination

　　Gas echo can be displayed between the diaphragm and the liver through the liver in a sitting examination.

　　4. Ultrasound examination

　　Most patients show a crescent-shaped free gas shadow below the diaphragm.

　　Acute perforation of peptic ulcer is one of the serious complications of peptic ulcer. Among all patients with peptic ulcer, acute perforation accounts for about 10-15%. Most of the ulcer perforations are duodenal ulcer perforations. After the operation for ulcer perforation, it is recommended that patients eat more of the following foods, which can help in the recovery from the disease.

　　1. Tofu

　　Tofu has a nutritional value similar to milk and can tonify Qi and clean the intestines. The saponins in the soy products used in tofu production have the effects of clearing free radicals in the body and anti-thrombotic effects. It is suitable for patients with gastrointestinal diseases and can be eaten regularly. It is recommended to eat 3-5 times a week, and soy milk, tofu pudding, and other soy products can also be used as substitutes.

　　2. Millet congee

　　Millet has the effects of preventing regurgitation and nourishing Yin and blood, which is helpful for vomiting and poor digestion. Due to the weak gastrointestinal function of gastric ulcer patients, semi-liquid food should be consumed. Millet congee can be used as staple food, eaten 3-5 times a day, with a small bowl each time.

　　3. Bananas

　　Bananas can alleviate the stimulation of stomach acid and protect the gastric mucosa by eating 1-3 times a week after meals.

　　The treatment method for acute perforation of peptic ulcer should be selected according to the severity of the disease. If the condition is severe, surgery is often required. Currently, there are two commonly used surgical methods, and I will introduce them specifically.

　　1. Simple Perforation Suture

　　The advantage is that the operation is simple and easy to perform, the operation time is short, and the risk is low. Especially in remote mountainous rural areas, even in cases of simple equipment, it can be performed. The disadvantage is that the long-term effect is poor, with a recurrence rate of 70% within five years, and a second complete operation is required.

　　2. Subtotal Gastrectomy

　　The advantage is that a single operation solves both the perforation problem and the treatment problem of ulcer disease. The long-term effect is satisfactory for more than 95%, but the operation is complex and dangerous. Certain surgical equipment and technical conditions are required. Whether to choose simple perforation suture or subtotal gastrectomy depends on the specific condition of the patient, local surgical conditions, and the surgeon's experience, etc. The first consideration should be to ensure the patient's safety.