What is a Gastric Perforation?

 

A perforation is a hole that grows through a wall. Gastric perforation is a full-thickness injury of the wall of the stomach [1]. The peritoneum is a layer that surrounds the stomach. Because of the perforation of the stomach wall, the contents of the stomach are released into the peritoneal cavity.

 

The suspicion of perforation is based on the clinical presentation of the patient and the report of diagnostic imaging revealing extra-luminal free-air, that confirms the diagnosis.

 

The perforations can present acutely or in an indolent manner (e.g. abscess). The treatment options depend upon the cause of perforation. Some perforations require a surgical approach while others are treatable with a non-operative methods [2].

 

 

 

What are the Symptoms of Gastric Perforation?

 

Because of perforations, the contents of the stomach are released into the abdomen or peritoneal cavity. This causes an infection called peritonitis. [3]

 

Peritonitis is a severe inflammatory condition. The symptoms include:

 

• Severe abdominal pain
• Bloating
• The feeling of fullness in the abdomen
• Nausea
• Vomiting
• Diarrhea
• Loss of appetite
• Not able to pass stool or had
• Reduced urine
• Thirst
• Fever
• Chills
• Shock
• Confusion
• Laziness

 

 

 

What are the Causes of Gastric Perforation?

 

The causes of gastric perforations are as follows: [4]

 

• Penetrating trauma such as knife injury that punctures the lower chest or abdomen. In most cases of penetrating trauma, the small intestine is injured because it occupies most of the area of the abdominal cavity.

 

• Automobile injuries often result in blunt abdominal trauma to the stomach that results in perforation.

 

• Ingestion of NSAIDs (nonsteroidal anti-inflammatory drugs) and steroids to elderly people with diverticular diseases increases the risk of colonic perforation.

 

• Bacterial infection e.g. typhoid fever may be complicated by gastrointestinal perforation.

 

• Gastric perforation is also caused by malignancies such as intra-abdominal lymphoma, metastatic renal carcinoma, and Desmond tumors can cause gastrointestinal perforations.

 

Some other causes of gastric perforations include:

• Perforations secondary to intestinal ischemia (ischemic colitis)
• Foreign bodies
• Appendicitis
• Laparoscopy
• Crohn's Disease
• Peptic Ulcer Disease
• Ingestion of caustic substances

 

 

 

What are the Treatment Options for Gastric Perforation?

 

There are two treatment approaches for gastric perforation [5]

• Medical Therapy
• Surgical Therapy

 

In medical therapy, the goal is to eradicate infection and minimize postoperative complications. Antibiotics are used before surgery for patients having intraperitoneal infections and bloodstream infections. Antibiotic therapy is used effectively with non-operative policy if signs and symptoms of generalized peritonitis are absent.

 

The surgical treatment is intended to correct the underlying anatomical problem, fix the cause of peritonitis, and remove foreign objects that were accumulated because of perforations such as feces, blood, gastric or intestinal secretions, and bile.

 

 

 

References:

1. https://www.ncbi.nlm.nih.gov/books/NBK519554/
2. https://www.uptodate.com/contents/overview-of-gastrointestinal-tract-perforation#:~:text=Pathophysiology%20%E2%80%94%20Perforation%20requires%20full%2Dthickness,perforation%2C%20subsequently%20releasing%20gastrointestinal%20contents.
3. https://medlineplus.gov/ency/article/000235.htm#:~:text=Perforation%20is%20a%20hole%20that,intestine%2C%20rectum%2C%20or%20gallbladder.
4. https://emedicine.medscape.com/article/195537-overview?form=login&scode=msp&st=fpf_login&socialSite=google&icd=login_success_gg_match_fpf&isSocialFTC=true#a8
5. https://emedicine.medscape.com/article/195537-treatment#d9

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