How to treat gastric perforation? It turns out there are two methods

As we all know, gastric perforation is a disease that is extremely harmful to the human body. Once it occurs, it will not only cause severe abdominal pain, but also cause complications if not treated in time, which is a very painful thing for people. So how to treat gastric perforation? Let’s take a closer look at the two treatments for gastric perforation!

1. Non-surgical treatment if perforation is on an empty stomach

There is relatively little leakage in the abdominal cavity, and there is no gastric contents such as food residues. The contamination of the peritoneal cavity is relatively light. There are no symptoms of poisoning (including fever, rapid pulse, rapid breathing, increased white blood cell count, etc.) in the manifestations of gastric perforation. The inflammation is relatively limited. Non-surgical treatment can be adopted for the treatment of gastric perforation.

Patients with gastric perforation were placed in a semi-recumbent position, fasted from food or water, underwent continuous gastrointestinal decompression, intravenous drip or continuous intravenous injection of omeprazole by microinjection pump to inhibit gastric acid secretion, and received intravenous fluid and nutritional support. Maintain water, electrolyte and acid-base balance, and routinely use antibiotics to control abdominal infections.

Changes in the patient's condition are judged by observing symptoms such as abdominal pain, fever, pulse, respiration, and abdominal signs. The control of abdominal inflammation is understood in a timely manner through rechecking blood routine, and abdominal ultrasound or CT reexamination is performed to clarify the absorption of intra-abdominal fluid.

Generally, relief of symptoms and signs after 3 to 5 days of non-surgical treatment can be considered a cure. For perforation on a full abdomen or perforation of unknown cause, consider cases with gastric tumors or pyloric obstruction and bleeding. Non-surgical treatment is not appropriate. In cases treated non-surgically, if abdominal pain and peritoneal irritation signs worsen, body temperature rises, or turbid fluid is aspirated during abdominal puncture after 12 hours of observation, and abdominal ultrasound or CT shows increased intra-abdominal fluid accumulation, and peritonitis is considered to have worsened or spread, the treatment of gastric perforation should be promptly transferred to surgery to avoid misdiagnosis.

2. Surgery

(1) Pure repair

It is the most commonly used surgical method in this group. Its advantage is that the location and severity of the lesion can be clearly detected through surgery, and abdominal cavity contamination can be cleared. Simple repair is simple and safe. Patients with gastric perforation recover quickly and without complications.

Acute perforation is one of the most common and serious complications of gastric ulcer, and hospitalization due to ulcer perforation accounts for about 20% of hospitalizations for ulcer disease. It has been reported that the mortality rate of gastric ulcer perforation is 27%. The older the age, the higher the mortality rate. The mortality rate can rise rapidly after the age of 80. The mortality rate is related to the length of time for surgical treatment after perforation. It is reported that if the operation is performed 6 hours after perforation, the postoperative mortality rate increases rapidly. So, what should we pay attention to in the diet and health care of gastric ulcer perforation?

Regarding the diet of patients with gastric perforation, we must pay more attention in daily life. In addition to regular and reasonable diet, it should be mainly high-protein and high-vitamin foods. Choose foods with high nutritional value, and I hope everyone will pay more attention to it in their daily diet.

Our selection points

①The patient’s general condition is poor. Peritonitis is more obvious, with a high white blood cell count or fever.

② Estimated postprandial perforation. There is a lot of abdominal leakage.

③ The estimated perforation time is >12 hours or the short-term non-surgical treatment is ineffective.

④ Short history of ulcer or no history of chronic ulcer.

⑤Young or elderly people with other chronic diseases.

Key techniques for simple repair treatment

① For simple perforation or small perforation, use silk thread to suture the seromuscular layer with three stitches parallel to the longitudinal axis of the stomach or duodenum and with the perforation as the center.

② For complex perforation or large-caliber perforation, the treatment of gastric perforation cannot be simply sutured. It can be filled with the greater omentum for suture or covered with the greater omentum after suture.

③ After the perforation is repaired, the abdominal cavity is thoroughly cleaned, 100-200 ml of 0.5% metronidazole is left in the abdominal cavity, the abdomen is closed, and an abdominal drainage tube may be placed as appropriate.

(2) Gastrojejunostomy

Some scholars believe that it is the preferred surgery for perforation. We believe that surgical cases still need to be strictly selected.

① The perforation is estimated to be <24 hours, the patient is in good physical condition, has no shock, has no severe abdominal infection, and the inflammation and edema around the perforation are mild.

② The perforation is located near the pyloric ring, and simple repair may cause pyloric stenosis.