A rarer complication of stomach ulcers is the lining of the stomach splitting open, known as perforation.
This can be very serious, because it enables the bacteria that live in your stomach to escape and infect the lining of your abdomen (peritoneum). This is known as peritonitis.
In peritonitis, an infection can rapidly spread into the blood (sepsis) before spreading to other organs. This carries the risk of multiple organ failure, and can be fatal if left untreated.
The most common symptom of peritonitis is sudden abdominal pain, which gets steadily worse. If you have this type of pain, contact your GP immediately. If this isn't possible, call NHS 111 or your local out-of-hours service.
Peritonitis is a medical emergency that requires hospital admission. In some cases, surgery may be needed. Read more about treating peritonitis.
The stomach is an organ of the digestive system, located in the abdomen just below the ribs and on the left. Swallowed food is squeezed down the oesophagus and pushed through a sphincter (small muscle ring) into the stomach, where it is mixed with powerful gastric juices containing enzymes and hydrochloric acid. The stomach is a muscular bag, so it can churn the food and break it down mechanically as well as chemically.
Once the food is the consistency of smooth paste, it is squeezed through a second sphincter into the first part of the small intestine (duodenum). The lining of the stomach – the mucosa or gastric epithelium – is layered with multiple folds. Ulcers occur in this lining.
The Helicobacter pylori bacterium (H. pylori) is the main cause of peptic ulcers. The discovery of this micro-organism in 1983 revolutionised many aspects of gastroenterology, including the treatment of stomach ulcers.
It is thought that about one in three people over the age of 40 years is infected with this strain of bacteria in Australia. The germs live in the lining of the stomach and the chemicals they produce cause irritation and inflammation. H. pylori directly causes one third of stomach ulcers and is a contributing factor in around three fifths of cases. Other disorders caused by this infection include inflammation of the stomach (gastritis) and dyspepsia (indigestion).
Researchers believe the germ could also play a contributing role in the development of stomach cancers. The infection is more common among poor or institutionalised people. The mode of transmission is so far unknown, but is thought to include sharing food or utensils, coming into contact with infected vomit, and sharing of water (such as well water) in undeveloped populations.
This is a serious complication of ulcer disease and is particularly deadly in the elderly or those with multiple medical problems. Bleeding from stomach ulcers is more common in people treated with blood thinning agents, such as warfarin, aspirin or clopidogrel (Plavix) and those people should also consider using regular anti-ulcer medication to prevent this complication.
A severe, untreated ulcer can sometimes burn through the wall of the stomach, allowing digestive juices and food to leak into the abdominal cavity. This medical emergency is known as a perforated ulcer. Treatment generally requires immediate surgery.
WHAT IS A PERFORATED ULCER?
A perforated ulcer is a raw place or sore in the lining of the stomach or upper intestine that makes a hole through the tissue. Acids that digest food, bacteria, and food may then move through the hole and into your belly. Blood vessels or other organs, such as your pancreas and liver, may be damaged. This could cause a life-threatening infection.
WHAT IS THE CAUSE?
The lining of the stomach and intestine normally keeps these organs from being hurt by stomach acid and digestive juices. If this protective layer breaks down, stomach acids can damage the walls of your stomach or intestine and cause an ulcer. If the ulcer gets too big or too deep, it can make a hole in your stomach or intestine.
Posted over a year ago
I had a duodenal ulcer and didn't know it...not until it ruptured and I experienced the worst pain of my life. And I've had several surgeries and given birth! I had been seeing a doctor for stomach pain who diagnosed acid reflux without doing any tests. I also suffer from terrible headaches and, with my doctor’s knowledge; I was eating Excedrin like crazy. I was in the process of finding another doctor for a second opinion when the ulcer decided to make itself really known. While at work I started having severe pains in my left side that radiated to my back. I was dumb enough to think that if I just went home to lie down I would be fine...and drove myself home with this mind numbing pain. I got home, changed into comfy clothes and lay down. Before I knew what hit me I was drenched in sweat, freezing (it was 112 outside that day) and convulsing so bad I couldn't even dial 911. My daughter came home and found me, she called the ambulance.
I coded in the ambulance. Once I got to the hospital I had to wait for awhile and coded again. I was finally taken for an ultrasound and then a CT scan. The CT scan showed the perforation and I was operated on immediately. I remember very little about the experience before the surgery, my family has filled in some of the blanks. Including the fact that my surgeon thought it would be a good idea to yell at me about taking Excedrin when I had an ulcer, even though I was seeing a doctor and didn't know I had the ulcer. He was none too happy with me when I responded by saying \"Could you save the lecture until after you fix the pain\".
Recovery was brutal. Tube in my nose, catheter somewhere else...and the surgery pain was unbelievable. I was in the hospital for 5 days on a clear liquid diet, and then my idiot surgeon decided I could go home (against the advice of the admitting doctor). I was barely moving around on day five. The hospital wouldn't release me until I'd had solid food...the solid food lunch for that day? Steak and potatoes, I kid you not. I refused to eat the steak, ate a bit of the potato and some jello and was on my merry way home with prescriptions for pain meds and Protonix. My family took me home, stopping at the pharmacy on the way to get the meds. My idiot surgeon had forgotten to write the dosage for the pain medication and was unreachable...until the NEXT MORNING at 11 a.m. Needless to say my first night home was horrendous. I almost went back to the hospital about three times. The pharmacy was wonderful, calling the surgeon every hour until they finally reached him, then calling to let me know the medicine was ready.
My surgeon said I could go back to work in a week...the admitting doctor (who wanted me in the hospital for at least three more days) said two. When I went to get my staples out (nine) 5 days after getting out of the hospital I told the surgeon I had no idea how I was going to go back to work the following Monday. I am an Administrative Assistant at a huge law firm. He had the impression that I just sat at a computer all day (which really didn't matter, because of the location of the incision sitting for any length of time was impossible). I had to explain in detail that I was extremely active at work and that my job was a very demanding one. If the attorneys and staff saw me at work they would think I was 100 percent and expect me to do all that I had before and I was just not ready. He finally agreed to let me off for another week.
At the next check up, the Friday before the Monday that I was again to return to work, I was in unbelievable pain. I had an extreme burning sensation in my abdomen. I explained this to the surgeon, who said it just takes time to heal and let me off work for another week.
The next visit, again the Friday before I the Monday I was to return to work, same thing. I was in such unbelievable pain, the burning was so intense. After basically breaking down in the office, telling the doctor that I just thought something was really wrong, I'd had surgeries before and had never experienced this type of pain. Plus I was SO weak and tired. He finally said \"well I guess it's possible that you have a yeast infection. I can give you some antibiotics and see if that helps\". Three days after beginning the antibiotics I was 75% better. The burning was nothing compared to what it had been and I was finally starting to sleep through the night.
I haven't been back to the surgeon since. I am still having issues with diet...what I can eat, what I can't. I lost 27 pounds (and I was pretty thin to start). I can no longer eat tomato based products, anything rich or too sweet, anything that is too spicy (Mexican is my favorite food - no more of that), etc. Red meat is not my friend; it causes stomach pain, as does the tomato based foods like spaghetti or pizza (my favorite food prior to surgery) or rich foods such as fettuccine alfredo. I was also a chocoholic before the surgery - now it makes me sick.
Of course there is no sympathy from my overweight boss who said things like \"it must be nice\" when she saw how much weight I had lost. (Of course she also said \"it must be nice\" when I was lying in the hospital bitching because I couldn't DO anything). She is constantly trying to get me to eat the cake, cookies and other sweets she is so fond of (and that I loved before the surgery), or the rich lunches she enjoys, and gets upset when I tell her I can't eat them because they make me sick. She then goes to my friends at work and tells them how worried she is about me because I don't eat. I DO eat; I just eat healthier than I ever have. I just eat plain, boring foods. Chicken or fish that is not seasoned too much, yogurt, cottage cheese, baked potatoes, etc. I also drink SlimFast with my meals; it tastes better than Ensure, has 250 calories, and has vitamins & minerals it in.
My advice to anyone who is experiencing stomach pain? Keep hounding your doctor. Find a new doctor if yours won't listen to you, and do it quickly. And the best advice I can give you - avoid NSAID's. Excedrin, Motrin, Aleve, they're all really hard on your stomach. The only thing that is \"safe\" is Tylenol. It may not work as well as the others, but taking it in place of NSAID's might save your life.
Signs of Perforated Peptic Ulcer
Someone with a perforated ulcer lies quietly and breathes shallowly. He may be pale and clammy, and the heart rate is likely to be rapid. The abdomen is rigid to the touch and tender. Light tapping on the abdomen will often produce a hollow, drumlike sound. The diagnosis can be confirmed with a simple x-ray showing abnormal gas collections inside the abdomen.
Although the classic symptoms and signs are usually present and lead your doctor to make a correct diagnosis, perforated peptic ulcer may be confused with other inflammatory diseases of the abdomen. In 1926, actor Rudolph Valentino was mistakenly diagnosed with and operated upon for appendicitis rather than his perforated ulcer. He died of peritonitis, giving his name to "Valentino Syndrome."
Symptoms of Perforated Peptic Ulcer
The first symptom of a perforated peptic ulcer is usually intense and severe pain. The experience is so drastic, you'll remember exactly when it happened, where you were, what you were doing, and even the exact words being spoken by a companion or on television. The pain is at its maximum immediately and persists, being worsened by movement, jostling, touching, coughing or sneezing. You may also experience fainting, excessive sweating and a rapid heartbeat.
Symptoms That May Precede Perforation
Although perforation may be the first symptom of peptic ulcer disease, it is often preceded for days or weeks by milder symptoms. Pain between the breastbone and the navel may occur when the stomach is empty and may be relieved with antacids. The pain may come and go and may be worse at night. Dark, tarry bowel movements or the passage of what appear to be coffee grounds may signal bleeding from a peptic ulcer.
Perforated Duodenal Ulcer.Thread discussing Perforated Duodenal Ulcer
Signs and Symptoms of a Perforated Peptic Ulcer | LIVESTRONG.COM
Stomach ulcer | Better Health Channel
Summit Medical Group - Perforated Ulcer
Stomach ulcer - Complications - NHS Choices
Last edited by Medical Photos; 09-23-2015 at 08:50 PM.
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