Gastric and Duodenal Ulcer Perforation: Symptoms and Clinical Insights

Gastric and duodenal ulcer perforation is a serious medical condition that presents with sudden, severe upper abdominal pain. Patients often experience nausea and vomiting alongside the pain. Clinically, the abdomen typically shows signs of tenderness, rebound tenderness, and muscle guarding, which are indicative of peritoneal irritation.

Physical Examination and Diagnostic Findings

During physical examination, generalized abdominal tenderness is commonly observed. As the condition progresses, patients may develop a rigid, board-like abdominal stiffness due to peritonitis. Laboratory tests often reveal elevated white blood cell counts and increased neutrophil percentages, signaling an inflammatory response. Additionally, liver and kidney function tests may show abnormalities, reflecting systemic involvement.

Imaging studies, particularly abdominal X-ray or CT scan, can detect free air under the diaphragm—a key sign of gastrointestinal perforation. This radiographic finding supports the diagnosis and helps guide further management decisions.

Treatment Approaches and Surgical Intervention

Once a perforation is confirmed, prompt surgical intervention is crucial. Exploratory laparotomy is typically performed to assess the extent of damage and repair the perforation. In some cases, a partial gastrectomy or resection of the affected duodenal segment may be necessary to prevent recurrence and ensure optimal recovery.

Management of Complications

Some patients may also develop hypovolemic shock due to significant blood loss. In such situations, timely fluid resuscitation and blood transfusions—using packed red blood cells or colloids like hydroxyethyl starch—are essential before surgery. Postoperatively, intravenous nutritional support is often required to aid healing and reduce the risk of complications such as intra-abdominal infections or abscess formation.

Antibiotic therapy and close monitoring are integral parts of post-surgical care to prevent sepsis and promote recovery. Proper management, including pain control and early mobilization, plays a vital role in improving patient outcomes and reducing hospital stay.