Acute perforation of gastric and duodenal ulcers is a common and serious complication, with duodenal ulcers being more prone to perforation. During acute perforation, a large amount of gastric and duodenal contents suddenly flows into the abdominal cavity, first causing chemical peritonitis. Within hours, gastrointestinal bacteria that have entered the abdominal cavity begin to multiply, gradually leading to bacterial peritonitis. In severe cases, shock may develop as a complication.

bubble_chart Clinical Manifestations

Most patients have a history of gastric or duodenal ulcers and suddenly experience persistent, knife-like severe pain in the upper abdomen. Due to the abdominal pain, they are afraid to move. This may be accompanied by nausea, vomiting, and abdominal muscle tension, which can become board-like rigidity, with significant tenderness and rebound tenderness. In the early stages, the patient's body temperature does not rise. However, due to the strong chemical irritation from gastric and duodenal fluids after perforation, symptoms such as pale complexion, cold sweating, cold limbs, thready and rapid pulse, and decreased blood pressure may occur. In the late stage (third stage), as intestinal bacteria enter the abdominal cavity and cause infection, the patient develops symptoms such as high fever, intestinal paralysis, and abdominal distension and fullness. Due to gas from the gastrointestinal tract entering the abdominal cavity, X-ray examination may reveal free gas under the diaphragm.

bubble_chart Diagnosis

1. Symptoms

(1) Most patients have a history of ulcers, and recent exacerbation of ulcer symptoms.

(2) Epigastric knife-like pain that gradually spreads to the entire abdomen, sometimes radiating to the shoulders and back.

2. Signs

(1) Abdominal tenderness and muscle rigidity throughout, especially severe in the right upper quadrant.

(2) Reduced or absent liver dullness.

(3) Decreased or absent borborygmus.

3. Auxiliary Examinations

(1) Free gas under the diaphragm visible on X-ray or abdominal fluoroscopy.

(2) Yellowish turbid fluid obtained via abdominal puncture, with litmus paper showing an acidic reaction.

bubble_chart Treatment Measures

Treatment Measures:

1. Non-surgical Treatment

(1) Suitable for younger patients with a short ulcer course, small perforation, minimal fistula disease content entering the abdominal cavity, and localized peritonitis, but close monitoring of condition changes is required.

(2) In the absence of shock, adopt a semi-recumbent position, fasting, gastrointestinal decompression, administer antibiotics, intravenous fluids, correct typical edema and electrolyte imbalances, and maintain acid-base balance.

(3) Combine with acupuncture therapy. After three days, consider administering Chinese medicinals as appropriate, such as modified compound formula Major Bupleurum Decoction.

2. Surgical Treatment

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

(2) Surgical methods: (1) Perforation suturing with mesh membrane coverage. Suitable for cases with prolonged perforation and severe abdominal contamination; elderly or frail patients unsuitable for gastrectomy; cases where the surrounding tissue is soft and suturing presents no technical difficulties. (2) Partial gastrectomy. Suitable for cases with short perforation duration and mild inflammation; gastric ulcer perforation; duodenal ulcer perforation with bleeding; cases where perforation suturing may lead to pyloric obstruction.