Acute perforation of gastric and duodenal ulcers

　　During the active phase of gastric and duodenal ulcers, if the ulcer is not controlled and continues to develop, it will erode the submucosal and muscular layers of the gastrointestinal tract, eventually piercing the serous membrane to form a hole connecting the gastrointestinal cavity with the abdominal cavity. At the same time, gastrointestinal fluid flows into the abdominal cavity through this hole, causing localized or diffuse chemical peritonitis. After 6-8 hours, bacterial proliferation occurs, and bacterial peritonitis develops. Perforation is more common in the anterior wall of the duodenum, and the diameter is usually about 0.5 cm.

　　Acute perforation of gastric and duodenal ulcers can also cause some complications, common complications include:

　　1, Peritonitis: It is the inflammation of the parietal peritoneum and visceral peritoneum of the abdominal cavity, which can be caused by bacterial, chemical, physical injury, etc. It can be divided into primary peritonitis and secondary peritonitis according to the pathogenesis. When acute purulent peritonitis involves the entire abdominal cavity, it is called acute diffuse peritonitis.

　　2, Toxic shock: It is a syndrome caused by staphylococcal exotoxins, characterized by high fever, vomiting, diarrhea, confusion, and rash. It can quickly progress to a severe and refractory shock, mainly occurring in menstruating women who use vaginal cotton plugs, and the main symptoms are caused by toxins produced by Staphylococcus aureus.

　　Acute perforation of gastric and duodenal ulcers is a common surgical acute abdominal condition, with an acute onset, severe condition, and rapid changes, requiring emergency treatment. If not treated properly, it can be life-threatening. The common symptoms and signs are as follows:

　　I. Symptoms

　　1, Most patients have a history of ulcer and the symptoms of ulcer disease have worsened in recent days.

　　2、上腹刀割样疼痛，逐渐波及全腹，有时疼痛放射至肩背部。

　　2. Cutting-like pain in the upper abdomen, gradually spreading to the whole abdomen, sometimes radiating to the shoulder and back.

　　3. Accompanied by nausea and vomiting.

　　2. Signs

　　1. General abdominal tenderness, muscle tension, especially in the upper right abdomen.

　　2. The liver dullness is reduced or disappears.

　　3. Decreased or absent bowel sounds.

　　1. X-ray film and abdominal透视 show free gas under the diaphragm.

　　2. Abdominal puncture aspirates yellow turbid fluid, and the litmus paper shows an acidic reaction.

　　Most patients have a history of gastric and duodenal ulcers, and suddenly appear cutting-like continuous severe upper abdominal pain, unable to move due to pain, accompanied by nausea, vomiting, abdominal muscle tension, which may present as rigid rigidity, with marked tenderness and rebound pain. In the early stage, the body temperature of the patient is not elevated. Due to the strong chemical stimulation of the gastric and duodenal fluid after perforation, the patient may experience symptoms such as pale complexion, cold sweat, cold extremities, rapid pulse, and decreased blood pressure. In the later stage, due to infection caused by the entry of intestinal bacteria into the peritoneal cavity, the patient may experience symptoms such as high fever, intestinal paralysis, bloating, etc. Due to the entry of gastrointestinal gases into the peritoneal cavity, X-ray examination can see free gas under the diaphragm.

　　Acute gastric and duodenal ulcer perforation is a high-incidence season in autumn and winter, and at the intersection of winter and spring. Pay attention to maintenance and prevention in daily life. To prevent gastric and duodenal perforation, the following points should be done:

　　1. Live a regular life, pay attention to the combination of work and rest, maintain a pleasant mood, avoid overwork, and mental stress. Pay attention to keeping warm during the change of seasons, quit smoking and drinking, and eat less or no刺激性 food.

　　1. Try to avoid or use cautiously drugs that irritate the gastric mucosa. For example, hypertensive patients should try to avoid using antihypertensive drugs such as Erythromycin. When patients with arthritis or other diseases must take hormones or non-steroidal anti-inflammatory drugs such as Indomethacin, they should take gastric mucosal protectants or drugs that inhibit gastric acid secretion (H2 receptor blockers, proton pump inhibitors, etc.) at the same time, such as Tagamet, which belongs to H2 receptor blockers and is a commonly used acid suppressant. It can moderately inhibit the secretion of gastric acid and has relatively few side effects.

　　2. Once the patient shows symptoms of indigestion such as upper abdominal pain, bloating, nausea, etc., they should go to the hospital in a timely manner and undergo some necessary examinations. Once digestive ulcers are found, they should follow the doctor's advice for regular treatment and regular follow-up until the ulcer is completely healed.

　　Most duodenal ulcer perforations occur in the anterior wall of the bulb, and 60% of gastric ulcer perforations occur in the lesser curvature of the stomach. So, what are the examinations for acute gastric and duodenal ulcer perforation? The following experts introduce several examination methods:

　　1. General abdominal tenderness, muscle tension, especially in the upper right abdomen, with a reduced or disappeared liver dullness, and decreased or absent bowel sounds.
　　2. X-ray film and abdominal透视 show free gas under the diaphragm, and yellow turbid fluid is aspirated through abdominal puncture.
　　3. Routine Blood Examination
　　1. White blood cell countThe white blood cell count is usually between (15～20)×10^9/L, with an increase in neutrophils as the main feature.
　　2. Hemoglobin and Red Blood Cells:It often increases due to dehydration and blood concentration.
　　Four, Serum Amylase
　　It can moderately increase, but the ratio of serum amylase creatinine clearance rate (CAM/CCr) is within the normal range.

　　Patients with gastric and duodenal ulcer acute perforation should pay attention to smoking cessation and alcohol avoidance, eat less or no spicy food, and pay attention to soft, tender, and easy-to-digest food. The staple food, vegetables, and meat dishes such as fish and meat, especially beans, peanuts, and other hard nuts, should be cooked thoroughly and well-cooked to make them soft and tender for easy digestion and absorption. Eat less rough and fibrous food, and require food to be well-made and nutritious.
　　All kinds of food should be fresh and not stored for a long time for consumption. Eat fresh vegetables and fruits with little fiber, such as winter melon, cucumber, tomato, potato, spinach leaves, pak choi, apple, pear, banana, orange, etc. Pay attention to eating light and low-fat diet, which is easy to digest and absorb and conducive to the recovery of stomach disease.

　　Most patients have a history of ulcer disease and the ulcer symptoms have intensified in the past few days, perforation usually occurs suddenly at night on an empty stomach or after a meal, and non-surgical treatment and surgical treatment are usually adopted: Western treatment for acute perforation of gastric and duodenal ulcers.

　　FirstNon-surgical Treatment

　　1. Suitable for those with younger age, short ulcer course, small perforation, not much content leaked into the abdominal cavity, and localized trend of peritonitis, but need to closely observe the changes in the condition.

　　2. Take a semi-recumbent position without shock, fasting, gastrointestinal decompression, application of antibiotics, intravenous fluid therapy, correction of water and electrolyte imbalance, and maintenance of acid-base balance.

　　3. Combine with acupuncture treatment. After 3 days, Chinese medicine treatment can be taken according to circumstances, such as modified compound Da Chaihu Decoction.

　　SecondSurgical Treatment

　　1. Indications for surgery: (1) No improvement after 24 hours of non-surgical treatment. (2) Recurrent perforation. (3) Accompanied by pyloric obstruction or hemorrhage. (4) Elderly, poor overall condition, or suspected cancer.

　　2. Surgical methods: (1) Perforation suture and omental coverage. Suitable for those with long perforation time, severe abdominal contamination, and the elderly and weak who are not suitable for gastric resection, as well as those with soft surrounding tissue around the perforation without technical difficulties. (2) Partial gastrectomy. Suitable for those with short perforation time, mild inflammation, gastric ulcer perforation, duodenal ulcer perforation with hemorrhage, and those who may develop pyloric obstruction after perforation suture.