Ultrasound image of gastric perforation

This is an automatically translated article.

The article is professionally consulted by Master, Doctor Le Hong Chien - Doctor of Radiology - Intervention - Department of Diagnostic Imaging and Nuclear Medicine - Vinmec Times City International General Hospital. The doctor has many years of experience working in the field of diagnostic imaging and interventional radiology (endovascular intervention and extravascular intervention).

1. Symptoms and complications of gastric perforation

When gastric perforation, patients often have the following symptoms:
Symptoms of gastric perforation: Sudden, severe, continuous pain in the epigastrium caused by gastric juice flowing out into the abdomen. peritoneal burn. In addition, the patient may be pale, sweating, rapid shallow breathing, low blood pressure. Physical symptoms: Abdominal spasticity, prominent epigastric rectus muscles, involuntary continuous muscle spasms. Loss of pre-hepatic opacities due to gas escaping from the stomach taking up space in the pre-hepatic region. Low-grade turbidity caused by gastric juice flowing down the right colonic groove into the right iliac fossa and Douglas pelvis. Systemic symptoms: The patient is in shock, the pulse is slow at first, the body temperature drops, after a while the pulse returns to normal due to gastric acid overflowing into the abdomen. Lately, the pulse will increase and the body temperature will also increase. Sickle of air on X-ray: This is a decisive symptom to diagnose gastric perforation. Gastric perforation without crescent is considered obliterated with symptoms of pain localized in the epigastrium, spasticity or reaction in the right epigastrium or lower abdomen, with little spread to other areas, Gastrointestinal bleeding: When gastric perforation is combined with gastrointestinal bleeding, the patient will have stomach bleeding before, the symptoms are vomiting blood, passing black stools.

Gastric perforation, if not handled and treated promptly, will progress in a dangerous direction. Possible complications include:
Generalized peritonitis: This complication appears within 12 - 24 hours, signs of infection gradually increase, body intoxication, electrolyte disturbances, increased blood urea, impaired kidneys and comatose patients. Localized peritonitis: Signs of gastric perforation gradually decrease and localize to one area, high fever fluctuating, loss of appetite, feeling very uncomfortable when breathing heavily, pain in the subdiaphragmatic region, deep pressing pain with symptoms localization. Possible hiccups, vomiting, ultrasound images of residual abscess.

2. Diagnosis of gastric perforation by ultrasound method

Abdominal ultrasound in gastric diagnosis is widely applied. In case of gastric perforation, the ultrasound image of gastric perforation will show:
Free air or free fluid or both air and free fluid in the abdomen on ultrasound image. The site of gastric edema can be seen at the site of perforation. Besides, in addition to the ultrasound diagnostic method of gastric perforation, if there is an air sickle on the X-ray film, the diagnosis will become certain, but when there is no air sickle, the diagnosis cannot be ruled out.
Computed tomography method has high diagnostic value, can show images such as air and free fluid in the abdomen, especially can detect the site of perforation.

3. Treatment of gastric perforation

People with gastric perforation, if diagnosed early and treated promptly, almost no death. However, mortality will increase due to peritonitis, infection, severe toxicity, acute renal failure .... Therefore, the principle of treatment is indication for emergency surgery, except for a very few cases. was diagnosed with perforation. Before surgery, it is necessary to prepare the patient well, the preparation time depends on the patient's condition. The preparation includes preoperative gastric suctioning, rehydration with electrolytes and necessary nutrients, pain relief and preoperative antibiotic use for the patient. The treatment methods are as follows:
Gastrectomy: This is a radical surgery, both treating gastric perforation and treating the root cause of stomach ulcers. Gastrectomy is a difficult surgery, leaving many serious long-term sequelae, so gastrectomy should not be abused in the emergency. Indications for gastrectomy are only performed in cases of gastric perforation due to cancer or when there is doubt between perforation of benign ulcer and perforation of cancerous ulcer. X-neurectomy and suture with or without surgical drainage: After neurectomy, the rate of re-ulceration varies depending on the method. Like emergency gastrectomy, neurectomy requires careful selection. Single hole stitching: Perforation stitching method accounts for a high percentage and is widely applied. However, the main disadvantage of this method is that it only treats the perforation complication, but does not cure the gastric ulcer and requires re-operation.

Endoscopic perforation suture: Endoscopic perforation suture is currently applied, the advantage of this method is that it is less invasive, can suture the perforation and is combined with highly selective X-neurectomy or Taylor surgery. . However, endoscopic perforation suture requires strict indications and also needs to be studied further. Perforation suture combined with antisecretory therapy: Perforation suture surgery alone has a high rate of having to re-operate. This method requires treatment in combination with anti-secretory drugs after suturing. Perforation suture combined with H. pylori eradication therapy: Treatment of complications of perforation and bleeding, when H. pylori is positive is necessary. Treatment of H. pylori also minimizes the rate of ulcer recurrence. Vinmec International General Hospital with a system of modern facilities, medical equipment and a team of experts and doctors with many years of experience in medical examination and treatment, patients can rest assured to visit. and treatment of gastric perforation at the Hospital.

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