Gastric perforation. A hole that develops through the entire wall of the esophagus , stomach, small intestine, large intestine, rectum, or gallbladder , with the consequent passage of gas and food fluids into the abdominoperitoneal cavity. This condition is a medical emergency.
Summary
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- 1 General
- 2 Frequency
- 3 Etiology
- 4 Symptoms
- 5 Diagnosis
- 6 Treatment
- 7 Sources
General
The importance of the following process cannot be overlooked: if there are reasonable suspicions, gastric perforation can be diagnosed quickly enough that surgical intervention almost always saves your life .
Frequency
In 1963 more than 100 described cases were found and in 1965 this number had increased by more than 150. Many cases have not been published. We have found 5 cases in Baltimore in a single year, therefore it cannot be considered a rare process.
Etiology
Many perforations are complications of peptic ulcers, others are attributed to birth trauma, and a few are due to ulceration caused by permanent catheters. Some perforations have been thought to be due to rapid excessive gas distension during the positive pressure resuscitation technique and others to excessive distention from distal obstructions of the stomach.
Most of those not included in the above groups have been attributed to rupture of weak points in the gastric wall, in which the muscle has been claimed to be congenitally defective. This theory, first proposed by Herbut in 1943 , has been widely accepted. Shaw et al., Demonstrated in 1965 that all stomachs have essentially weak points between the numbers of the external muscular layer and that, after excessive distension with air , there are breaks in one or more weak points.
The fine border of the perforation will show only mucosa and submucosa under the microscope , while the muscular layer will be retracted 2 to 10 cm from the border of the mucosa . This does not appear to be a birth defect, but the stomachs of all newborns may rupture if the intragastric version increases sufficiently. White believes that in the supine position, the air trapped inside the stomach is effectively trapped, and that continued swallowing of more air can cause intragastric pressure to rise to dangerous levels.
In the three years since the infants in the Johns Hopkins Hospital and Baltimore City Hospital newborn wards have been kept in the prone position, no cases of gastric perforation have been found.
Symptoms
Perforation of the intestine leads to the leakage or leakage of the intestinal contents into the abdominal cavity , causing a serious infection called peritonitis . Symptoms may include:
- Severe abdominal pain
- Shaking chills
- Fever
- Sickness
- Vomiting
Diagnosis
Premature infants are more prone than gastric perforation term babies (58 out of 90 in the Reams series and 6 out of 8 in the Shaw series). In general, there are usually no complications in pregnancy , at work , or during labor, and children seem to be doing well initially. The symptoms usually start on the third or fourth day, although it can start from the second to the eighth day, and consists of refusing to eat, vomiting, respiratory distress and cyanosis , following a rapidly progressive abdominal distension .
The physical examination reveals moderate to extreme abdominal distension. Tympany is generally found by percussion in the upper two thirds of the abdomen , which hides the normal dullness of the liver , but variable dullness with the change of position in the lower third. Often the meteorism is so great that it makes breathing difficult and produces cyanosis. In several cases, pitting edema has been observed in the abdominal skin. The scrotal sac may be filled with air.
The radiograph of the abdomen without contrast shows the presence of large amounts of liquid and air in the peritoneal cavity. Take an x-ray in the orthostatic position. You can discover a lot of open air, that is, outside the gastrointestinal light.
Sometimes a large air blister is seen above the hepatic dome, but below the diaphragm , when the examination is performed with the child in the orthostatic position. When there is a concomitant high obstruction, gastric dilatation may be found or the characteristic double blister of duodenal obstruction may be visualized.
Treatment
Surgical intervention and occlusion of the tear will be performed immediately. Otherwise a bacterial peritonitis will occur and a serious complication would be combined with a state in itself, quite dangerous. When the most obvious tear has been repaired, other possible ones will be looked for immediately, because there are not often multiple perforations. Then the surgeon must look for the presence of the fundamental vice and, if he finds it, he will simultaneously effect the presence of it. The omission of this procedure results in the death of the patient. Sometimes a perforation was occluded, but two more perforations and duodenal atresia were discovered in the new operation two days later.causing all three, which had been overlooked. Unfortunately then it is too late to get the patient cured.
Of our last 5 patients, 4 survived. The prognosis in the series by Reams et al., Was 50% survival in patients operated on within 12 hours from the start and 25% in those operated on later.
