Penetration of stomach ulcers and 12 duodenal ulcers. Penetrating ulcer

Penetration of a stomach ulcer is the spread of a pathological process outside the organ. According to WHO statistics, penetration ranks third among complications peptic ulcer stomach after bleeding and perforation.

It occurs in 10-15% of cases, mainly in young men under 40.

This complication occurs against the background of a long-term peptic ulcer disease. In the tissues forming the ulcer defect, irreversible morphological changes occur, in which the cells lose their ability to regenerate. The ulcer becomes callous - cicatricial is present in its structure connective tissue, the edges and bottom are made dense and rough.

During penetration due to necrosis, a defect occurs in all layers of the walls of the stomach. The ulcer opens into adjacent organs, forming fibrous adhesions with them.

In case of untimely diagnosis and treatment, fistulas are formed, through which the contents of one organ penetrate into the cavity of another. This stage can result in sepsis or massive internal bleeding.

Development reasons

For the development of penetration, conditions are necessary:

1. Chronic callous ulcer without signs of regeneration, but on the contrary, with necrosis of the stomach wall.
2. The ulcer defect should be small, about 1 cm in diameter (a large opening will cause a significant amount of gastric secretion to be ejected, that is, perforation, bleeding, shock will occur). The formed ulcer cavity contains gastric juice, which maintains a continuous inflammatory process of the surrounding tissues.
3. Adhesion processes in the upper abdomen, which are caused by trauma, surgery or inflammation of any organs of the abdominal cavity. Adhesions arise from the tendency of the peritoneum, the serous membrane that covers all organs of the abdominal cavity, to fence off the damaged area. It sticks to the affected area; over time, dense fibrous cords form from the peritoneum to the organ, which limit the mobility of the organ.

Factors contributing to the formation of symptomatic stomach ulcers

In addition to gastric ulcer, which has a polyetiological nature, symptomatic ulcers can form on the gastric mucosa. They occur as secondary in various severe pathologies (burns, trauma, surgery), when taking ulcerogenic drugs or in psycho-traumatic situations.

They differ from peptic ulcer disease in superficial lesions of the epithelium of the gastric mucosa, benign course (there is no tendency to complications and malignancy), rapid regeneration when the causative factor is eliminated.

• frequent stressful situations;
• poor nutrition;
• tobacco smoking, alcohol abuse;
• long-term intake medicinesthat have a negative effect on the gastrointestinal mucosa (non-steroidal anti-inflammatory drugs, hormonal drugs).

Penetration mechanisms of gastric ulcer

As a result of the progression of necrosis, all layers of the stomach are destroyed, and the resulting defect does not open into a free abdominal cavity, and in the organ adjacent to the stomach. The wall of the adjacent organ becomes the bottom of the penetrating ulcer. Aggressive gastric juice containing hydrochloric acid and proteolytic enzymes gradually begins to dissolve the organ wall.

The organs into which the ulcer penetrates are determined by its location in the stomach. Most often, penetration is carried out into the pancreas, then, according to the frequency of lesions, there are: liver, small omentum, hepato-duodenal ligament, gall bladder, the walls of the small and large intestine.

Stages

On first stage superficial erosion of the organ wall begins. A focus of inflammation is formed around. Outside, the adjacent organ is soldered to the stomach.

In second stage all layers of the stomach are destroyed, but the pathological process has not yet gone beyond the limits of the organ. There is no penetration of the ulcer into a neighboring organ.

IN third stage the ulcer spreads to the adjacent organ, a superficial defect forms on its wall. The structure of the organ changes, the tissues are hardened and hardened. Fibrous cords tighten the stomach - it is deformed.

In the fourth stage, deep cavities are formed in the penetrated organ with foci of inflammation in the surrounding tissues.

Symptoms of pathology

If a stomach ulcer opens with penetration into a neighboring organ, the symptoms of the disease change significantly.

1. Pancreas. Pain in the left side: severe, intense, radiating to the back, sometimes becoming shingles. Nausea, vomiting, and fever rise to febrile numbers appear.
2. Large intestine (transverse colon). During penetration, a hole is formed that connects the stomach to the large intestine - a gastrointestinal fistula. Fecal matter enters the stomach, and undigested food from the stomach enters the intestine. Typical symptoms are: defecation with fresh food immediately after eating; vomit contains feces. Strong weight loss is noted.
3. Lesser omentum (this is the part of the peritoneum between the liver, stomach and duodenum). The pains are localized on the right, under the costal arch.
4. Liver. With the penetration of the ulcer into the liver, a picture of acute hepatitis occurs. Dull aching pains with localization in the right hypochondrium. Nausea is constant, but vomiting is rare. Asthenia symptoms: weakness, fatigue, drowsiness during the day, insomnia at night.
5. Biliary tract and small intestine. Vomiting mixed with bile and intestinal contents.
6. Penetration in the diaphragm (the muscle septum that separates the chest and abdomen) causes chest pain, often mistaken for heart pain.
7. Penetration into the retroperitoneal space leads to the development of the most severe purulent-septic process with symptoms of intoxication: heat, chills, sweating, tachycardia.

Diagnostics

Diagnosis consists of anamnesis of the disease, patient complaints, symptoms, examination data, laboratory and instrumental methods survey.

Clinical blood test: leukocytosis, accelerated ESR.

Blood biochemistry. When the liver or pancreas is damaged, specific markers appear in the blood, showing the degree of dysfunction of these organs.

With FGDS, an area with a deep ulcerative defect in the form of a crater surrounded by a roller of inflamed tissue is revealed. If you suspect malignancy, a piece of tissue is taken from the ulcer to conduct histological examination on atypical cells.

X-ray examination is carried out with a contrast agent. X-ray signs of ulcer penetration: deep niche, immobility of the formation. Often in ulcers, a triple content is noted: gas, liquid and contrast. Contrast agent when a fistula is formed, it passes into the colon or biliary tract.

Ultrasound of the abdominal cavity reveals abnormalities in the organs involved in the pathological process.

In doubtful cases, they resort to diagnostic laparoscopy - using fiber-optic technology, it is possible to visually examine the degree of damage to organs and tissues.

Useful video

How not to face such a disease as an ulcer can be found in this video.

Treatment

Conservative therapy is ineffective. Penetrating gastric ulcers do not undergo reverse healing. The disease has a progressive course, the forming changes lead to severe complications that can be fatal. If the patient feels a change in the nature of the pain, noticed the appearance of new symptoms - this is a reason to assume that the stomach ulcer has opened, and you should immediately seek medical help.

Before the operation, depending on the stage of the disease, symptomatology, the patient's well-being, several courses of antiulcer treatment, removal of inflammation, and normalization of homeostasis are carried out. Surgical operations on the stomach are performed according to various methods:

Rehabilitation after such operations lasts from six months to a year. For successful recovery in postoperative period the patient is prescribed a strict diet, a course of drug anti-relapse therapy, sparing physical activity.

Complications:

• profuse internal bleeding from damaged vessels of adjacent organs;
• perforation with the outflow of gastric contents into the free abdominal cavity, followed by the development of shock, peritonitis;
• when squeezed by an inflammatory infiltrate of the outlet of the stomach, a violation of the advancement of the food lump occurs;
• malignant transformation of a callous ulcer.

Forecast

If you do not carry out a radical surgical treatmentthen a progressive penetrating ulcer will cause complications.

With a timely operation, the prognosis is favorable.

Diseases digestive system are the most frequent complaints of patients. The complication of the ulcer leads to penetration. It is observed in men against the background of inflammation of a chronic ulcer.

Untreated stomach ulcer leads to penetration

general description

Penetration of a stomach ulcer is a condition in which pathology enters neighboring organs. That is, it spreads beyond its walls. Inflammation develops, fibrous adhesions are formed (due to the ability to adhesion processes). In the affected area, the ulcer deepens inward. When it becomes through, inflammation is transferred to the wall of a nearby organ.

If the bulb is affected twelve duodenumthen the pancreas is affected (also the bile ducts and liver). According to the international classification ICD 10, the disease code is K25.

Macrodrug No. 11 contains a small fragment of the mucous membrane of the stomach wall with an ulcerative defect and the pancreas located behind it. Microdrug No. 106 - a chronic ulcer with an exacerbation, involving three membranes: mucous, submucous and muscular.

The defeat affects nearby organs

Causes of occurrence

There are two main reasons for the onset of the disease:

• ulcer: damage to the deeper layers of the stomach increases the possibility of developing penetration;
• formation of adhesions in the upper abdomen - when adjacent organs are in contact.

In addition, stress leads to the formation of peptic ulcer, not proper nutrition, alcohol abuse, intake drugsthat have a negative effect on the inner surface of the stomach.

The mechanism of occurrence of a penetrating ulcer is as follows:

Internal organs are capable of regeneration, therefore, during penetration, scar tissue is formed near the lesion. As a result, a fistula canal appears, which is not affected by gastric juice.

Steroid stomach ulcer is accompanied by pain and flatulence

A steroid stomach ulcer has its own characteristics. It can appear in a patient who does not suffer from this disease and dyspeptic disorders. The cause is heartburn, flatulence, pain in the epigastric region.

Important! Alcoholism contributes to the appearance of ulcers.

Development stages

Pathogenesis of penetration.

At the fourth stage, the degeneration of the disease into a cancer is possible

There are stages that characterize the development of gastric ulcer:

• pre-ulcer (mild);
• medium and severe course;
• complications;
• remission after surgery.

Signs

The disease is accompanied by the following symptoms:

Peptic ulcer of the duodenum or stomach is a pathology characterized by the formation of ulceration of the mucous layer of the organ wall. It can be caused by acidity or the presence of microorganisms. Peptic ulcer of the anastomosis occurs due to resection of the stomach. The patient has pains in the upper abdomen (from aching to acute), heartburn, belching, an unpleasant taste in the mouth is felt.

Peptic ulcer may occur after gastric resection

Diagnosis of the disease

If you suspect penetration, you should contact your local therapist who will determine the cause of your abdominal pain. A narrow specialist is a gastroenterologist, his profile is the gastrointestinal tract. An ulcer is diagnosed as follows:

• study of medical history;
• clinical examination;
• the appointment of laboratory tests (blood to determine the level of ESR and leukocytes, lactic and pyruvic acids);
• endoscopic examinations: fibrogastroduodenoscopy, X-ray of the gastrointestinal tract (to identify the course of the ulcerative defect), laparoscopy (visualization of the attachment of the organ to the stomach) and ultrasound procedure abdominal cavity (in order to study changes in the gastrointestinal tract).

To identify a penetrating ulcer, fibrogastroduodenoscopy is performed

After the diagnosis, a preoperative preparation plan is drawn up.

Treatment methods

If there is a suspicion of this disease, it is necessary to urgently call an ambulance emergency care... Before her arrival, the patient needs to be put to bed, to ensure peace and quiet, not to feed.

In the first and second degree of lesion, they are treated conservatively in stationary conditions (in the absence of complications). Medications are prescribed to normalize gastric motility; diet; regenerating preparations. Description conservative treatment is aware of internal medicine. If this therapy does not bring positive effect, the patient needs to be operated on.

The patient is prescribed conservative therapy

In the third and fourth phases (as a rule, during this period, complications of the disease occur), the lesion does not heal, only surgical intervention will help. With 1-2 types of penetrating ulcers, resection is prescribed. On initial stage lesions perform vagotomy with gastric drainage.

Uncomplicated peptic ulcer is treated on an outpatient basis. If a perforated pathology of the stomach or duodenum is detected, an emergency operation is necessary. As a last resort, you can apply the Taylor method: a gastric tube is inserted into the body, which ensures constant aspiration of the contents. In addition, an active course of antibiotics is prescribed.

The main goal of treatment is to achieve scarring and healing of the complication in a short time. In 20% of cases, the ulcer develops into oncology. It is not always possible to catch the beginning of this transformation. It is advisable to carry out postoperative rehabilitation in medical sanatoriums, in which an appropriate diet will be provided, drug therapy, healing procedures.

The Taylor Method involves continuous aspiration of stomach contents

Recovery prognosis

On early stage it is enough to observe proper nutrition and taking medications. If untreated, the prognosis is poor. Complication of ulcers contributes to shock, cancer, stenosis and death. Surgical intervention increases the chance of recovery. At the initial stages of development cancerous tumor it is necessary to remove the affected part of the stomach, apply radiation and chemotherapy.

With the right treatment, 9 out of 10 patients recover.

As a preventive measure, it is recommended to control stomach ulcers and duodenal ulcers, follow a diet (treatment table No. 1), and refuse food that increases acidity. You need to eat right: 3-4 times in small portions. You cannot eat at night. Must be overcome bad habits: alcohol and nicotine contribute to the transformation of the disease into oncology. It is desirable to provide rest during exacerbations.

Eating a healthy diet can help speed up your recovery.

Thus, a penetrating stomach ulcer and 12 duodenal ulcer is a dangerous pathology in which neighboring organs are affected. If such a diagnosis is made, it is necessary to immediately begin treatment, otherwise the outcome can be sad.

Ulcer penetration is the most dangerous complication of the underlying pathology. A similar problem is diagnosed in 10% of ulcers. Moreover, more often representatives of the strong half of humanity aged 40 and over are subject to this condition.

As a rule, a similar complication develops due to inflammation formed against the background of a chronic ulcer defect.

Clinical picture

When the mucous membrane of the duodenum or stomach is damaged, ulcerative pathology develops. If the defect in question deepens and destroys new layers, the following conditions may occur:

• opening of an ulcer defect into the cavity, called perforation;
• opening of a defect in a neighboring organ, referred to as penetration.

Penetration of stomach ulcers and duodenal ulcers is a defect entering other systems. Moreover, more often, the ulcer penetrates into the pancreas. Because it is this system that is the closest. Less commonly, pathology can affect the bile ducts or liver.

Important: If an erosive defect penetrates into a neighboring organ, then human body prone to adhesive processes.

The pathology in question develops inside the walls of the stomach and duodenum due to inflammation. If the defect is transformed into a through one, the inflammatory process is deployed on the wall of a neighboring organ in the zone where the ulcerative formation goes beyond the main affected system.

Often, the exit of erosion to a neighboring organ occurs if the wound area of \u200b\u200bthe stomach or duodenum is small. In the case when the erosive zone reaches more than 1.5 cm, ulcer perforation is formed, often accompanied by shock.

Causes

The main provocateur of the development of the ailment in question is a progressive ulcerative formation with a penetrating inflammatory process. In other words, if the treatment of gastroduodenitis or gastritis is not promptly started, the walls of the stomach become covered with ulcers, which subsequently appear on neighboring organs.

Excessive production of hydrochloric acid plays a large role in the formation of such a complication. And its excessive secretion is provoked by improper nutrition, infections and neglect of therapy aimed at normalizing the production of hydrochloric acid.

Constant exposure to hydrochloric acid increases the area of \u200b\u200binflammation. The result of such negative activity is a deep defeat of the walls of the organ and the formed penetrating ulcer.

In addition, the development of penetration can provoke a number of certain phenomena:

• callous ulcer formation, in which there are no signs of regeneration and there is necrosis on the walls of the stomach;
• erosive defect up to 1.5 cm in volume;
• excessive content of gastric juice in the resulting ulcerative cavity, which supports inflammation;
• adhesions in the upper abdomen caused by injuries, due to inflammation occurring in the abdominal cavity or as a result of an operation.

It is worth noting that adhesions are more often formed due to the serous membrane covering all abdominal systems, which tries to isolate the damaged area. These actions lead to the fact that serous membrane adheres to the zone of dislocation of the lesion, which over time leads to the formation of fibrous cords that hold down the mobility of organs.

Stages of development of pathology

The stages of development of the defect in question are identical for both the stomach and the duodenum. In total, a penetrating stomach ulcer has four degrees of formation, namely:

• at the initial stage, a superficial erosive lesion of the walls of the gastrointestinal tract is formed. As a result, an inflammatory focus is formed around. In this case, a partial adhesion of the organ adjacent to the stomach is observed outside;
• at the second stage of development, destruction of the layers of the stomach is observed. At this stage, the defective process does not go beyond the limits of the affected organ. At the second stage, the penetration of the ulcerative formation into the neighboring organ is not yet observed;
• at the third stage of development, the ulcerative defect spreads to a nearby organ, forming a wound on its surface. In this case, the affected organ is deformed, the tissues succumb to the sclerosing process and become denser. In parallel, fibrous cords also tighten the stomach, as a result of which it is deformed;
• and at the last fourth stage, cavities are formed in the system to be penitized, in which focal inflammations are observed.

It is worth noting on last stage a deep ulcer is formed, which is surrounded by the tumor.

Symptoms

If a patient has an ulcerative formation, accompanied by penetration into a neighboring organ, the symptoms will be as follows:

• emergence of strong pain... Moreover, such discomfort can be worried at any time of the year, day, and regardless of food consumption;
• the intensity of discomfort changes. If a person has a penetrating ulcer, pain occurs constantly, it can manifest itself in the area of \u200b\u200bthe shoulder, scapula, or be encircling;
• it is not possible to eliminate pain with the usual methods. Pain relievers and antacids do not provide relief. Moreover, emptying the stomach by inducing vomiting also does not give a positive result.

The clinical picture is determined by the defeat of the system where the penetration of the ulcer defect occurred, namely:

1. If the pancreas is affected, the discomfort will be of a pronounced intense nature, it can be given to the back or be shingles in nature. In parallel, the patient will be disturbed by nausea, vomiting and fever. Often, this symptomatology is confused with the development of pancreatitis. However, this condition has one difference, with pancreatitis, the pain is not systematic and is eliminated by painkillers;
2. Upon penetration into the large intestine, an opening is formed that connects the large intestine and stomach. In this condition, feces enter the gastric tract, and undigested foods, on the contrary, enter the intestine. A characteristic feature in addition to pain, there will be a bowel movement with undigested food immediately after taking them. In addition, particles of feces will be observed in the vomit;
3. If the small oil seal is affected. Pain occurs under the costal arch and excessive weight loss is noted;
4. With the penetration of ulcerative pathology into the liver, the symptoms will be identical, as will the appearance of acute hepatitis. The patient is tortured by the dumb aching pain in the right hypochondrium. The person feels constant nausea, while vomiting is rare. In addition, there is weakness, fatigue, insomnia at night, but in the daytime, on the contrary, you want to sleep;
5. In the case when penetration occurs in the area of \u200b\u200bthe biliary tract or small intestine, the patient will be bothered by constant vomiting with an admixture of bile, lack of appetite and sudden weight loss;
6. Penetration in the diaphragm zone signals severe pain behind the sternum, which is often confused with heart pain;
7. If the defect in question occurs in the retroperitoneal space, it will cause a dangerous purulent-septic process with signs of intoxication, such as fever, severe chills, tachycardia, excessive sweating.

In order to prevent penetration into one of the neighboring organs, peptic ulcer disease must be fought immediately at the first symptomatology. Of course, the best option would be to monitor nutrition and prevent the development of the root cause of penetration.

To redistribute the root cause, the gastroenterologist examines the patient's history. After that, an examination is carried out, additional laboratory and instrumental examinations are assigned.

When determining the root cause of the discomfort, special attention is paid to the presence of an erosive defect or the likelihood of its formation. In addition, the fact is taken into account whether the pain disappears after eating. The moment regarding pain is also important, whether it radiates to the upper and lower limbs, neck or arm.

As for instrumental and laboratory research, the following types of diagnostics are assigned:

• collection of biological fluid to study the erythrocyte sedimentation rate and to monitor neurophilic leukocytosis;
• examination using fibrogastroduodenoscopy;
• fluoroscopy to determine the depth of the affected area;
• laparoscopy. This type of diagnosis allows you to visualize the place where the defect has spread;
• ultrasound examination. It is performed for a detailed examination and analysis of all changes that have occurred in the pancreas and liver, provided that the erosive formation has penetrated into these organs.

After a thorough examination and diagnosis, the patient is assigned the most optimal type of pathology elimination.

Treatment

If a penetrating peptic ulcer pathology is diagnosed, surgery is prescribed. In this case, before carrying out such a manipulation, the patient needs to undergo preparatory intensive course, which includes the following activities:

• appointed drug treatment to eliminate the focus of inflammation;
• taking antiulcer drugs;
• the revealed violation of homeostasis is being corrected.

Important: This type of surgery is undoubtedly dangerous to the health of the ulcer. Since during manipulation 2/3 of the stomach is subject to resection.

Erosive formations in the second and third stages are treated conservatively. Moreover, such therapy is carried out within the walls of the hospital and under the strict supervision of a doctor. For these purposes, the ulcer is assigned the following groups of medicines:

• drugs that normalize the motility of the gastrointestinal tract;
• drugs of the antacid group;
• dietary food, the purpose of which is to eliminate the influence of provocateurs on the affected area;
• medicinal medicines that have a regenerating effect.

Important: Penetrating defects that have reached the third stage are eliminated only by surgical intervention... In addition, often the appointment for a surgical procedure is received by those patients in whom such a pathology is at an initial stage, but cannot be treated with medication.

Since the complication in question poses not only a danger to health, but also to the patient's life, the results of therapy are monitored using an X-ray apparatus.

As for the methods of surgical intervention, they often resort to the following methods:

• draining procedure;
• vagotomy;
• resection.

These methods of eliminating the pathology under consideration are considered the most effective.

Forecast

If an ailment is detected at the initial stage of development, the patient is recommended to undergo a set of therapeutic measures and strictly adhere to the diet. If the pathology is detected at a late stage, an immediate operation is required, and then strict control over one's own health in order to prevent the development of complications.

• the appearance of malignant tumors;
• development of stenosis.

Important: Timely treatment will allow you to get rid of the disease forever and lead a completely normal lifestyle.

Summarizing the above, it is worth taking stock. Penetration is a negative, irreversible process in which tissue damage and damage occurs. In view of this, the pathology is considered very dangerous not only for health, but also for the patient's life. Therefore, it is strictly forbidden to attempt self-medication or ignore the problem.

If there is a suspicion of such a defect, you should immediately contact a gastroenterologist and be examined. Timely contact with specialists will increase the chances of recovery.

Is the penetration of the ulcer. This happens when the ulcer, literally destroying the wall of the stomach, gradually penetrates into neighboring tissues. Adhesions, infiltration and even inflammatory tumors, perivisceritis develop. How ulcer penetration manifests itself depends on which organ will be involved in the pathological process.

Why does the penetration of stomach ulcers occur?

With rapid progression, the ulcer defect completely destroys the wall of the stomach, penetrating into the adjacent organs - the pancreas, gallbladder and others.

Penetration occurs during exacerbation of peptic ulcer disease. With the rapid progression of the destructive process (destruction of the stomach wall), closely located tissues and organs (small omentum, body of the pancreas) are involved in the pathological process. Penetration is formed gradually. There are 3 stages:

1. Necrosis of the stomach wall. Due to destructive processes during the formation of an ulcer, the mucous membrane is first destroyed. If timely and adequate treatment is not started, the pathology progresses. Gradually the cells of the muscle layer are destroyed and die off. As a result, necrosis of the entire part of the gastric wall occurs.
2. Fibrous fusion with an adjacent organ. If an ulcer has formed in a place where the stomach is in close contact with another organ, then fusion occurs at the site of perforation of the stomach wall. If the ulcer opens into the abdominal cavity, then this complication is called perforation.
3. Penetration into the tissue of the adjacent organ. With the destruction of the stomach wall, the inflammatory process passes to neighboring tissues, their further destruction occurs, adhesions occur. The contents of the stomach penetrate into the adjacent organ, infiltration occurs (inflammatory edema).

Ulcer penetration occurs during the progression of peptic ulcer disease, and this is facilitated by:

• stress;
• improper nutrition;
• bad habits;
• taking ulcerogenic medications;
• non-observance of the regime of work and rest (especially during the exacerbation of the ulcer).

To avoid complications, patients with peptic ulcer disease, especially during a seasonal exacerbation, should follow certain rules:

1. Stick to being strict. In case of peptic ulcer disease, treatment table No. 1 is recommended. Patients should avoid foods that increase the secretion of gastric juice (spices, smoked meats, strong tea and coffee, tomato sauces, etc.).
2. Eat right. You need to eat in small portions, 3-4 times a day, at the same time, and not at night, but during the day. Breakfast, lunch, dinner should be complete. No snacks on the run, especially fast food. And instead of breakfast, a cup of strong coffee (to wake up) for patients with peptic ulcer disease is a factor contributing to the rapid penetration of the ulcer.
3. Alcohol and nicotine contribute to the formation of ulcers, the rapid development of complications and malignancy (ulcer degeneration into).
4. Some medicines have ulcerogenic effects. Aspirin, caffeine, indomethacin, etc. contribute to the development and progression of peptic ulcer. Before using the drug, you must not only read the instructions, but also consult a specialist. The expediency and dosage of the use of any drugs is determined by the attending physician (not the neighbor who cured the ulcer, the Internet, advertising).
5. Treat stomach ulcers. Observe medical recommendations. Complete the course, and not stop taking medications as soon as the main symptoms of peptic ulcer disappear.
6. Observe the mode of work and rest. During the period when exacerbations of ulcers may occur (spring, autumn), night shifts and business trips should be avoided.

It is possible to determine the occurrence of ulcer penetration by the changed clinical manifestations peptic ulcer.

How is ulcer penetration manifested

Penetration in the direction of the diaphragm is accompanied by pains similar to those of ischemic disease hearts.

Signs of ulcer penetration depend on the degree of penetration of the pathological process into neighboring organs, and where exactly it penetrated. To suspect the presence of a complication of peptic ulcer disease should be based on the following changed characteristics of pain:

• pain ceases to be dependent on food intake;
• the circadian rhythm is lost;
• pain radiates to the back;
• antacids do not help relieve pain.

The clinical picture of gastric ulcer significantly changes, as symptoms and lesions of the lesser omentum are added.

Manifestations of symptoms depending on the involvement of other organs in the pathological process:

1. Penetration into the pancreas. The pain is persistent, radiating to the back. Often, when palpating the spinous processes of the vertebrae, patients complain of painful sensations. Appears, body temperature increases (up to 38.4 0 С). Sometimes the pain is girdle, but more often patients complain that it hurts in the left side.
2. Penetration into the small oil seal. The pain occurs in the right side, under the ribs.
3. Penetration towards the diaphragm. It hurts behind the breastbone, often painful symptoms are similar to pain in.
4. Penetration into a hollow organ (biliary tract, intestines). Vomiting occurs, an admixture of bile and intestinal contents is found in the vomit. Patients complain of bitter belching.
5. Penetration of a stomach ulcer into the transverse colon. A fistula is formed, through which fecal matter enters the stomach, and the contents of the stomach enter the intestines. There is vomiting with an admixture of feces, belching with feces. The act of defecation occurs almost immediately after eating, in the form of fresh food. There is a sharp weight loss.
6. Penetration into the tissue of the retroperitoneal space. The phlegmon of the retroperitoneal space develops. Signs of a severe purulent-septic process appear (high body temperature, chills, sweating, intoxication).

According to the changed clinical picture the diagnosis is not made. To confirm the penetration of the ulcer, additional studies are carried out:

• Ultrasound, CT scan of the abdominal organs;
• laparoscopy.

Treatment of ulcer penetration is radical. An operation is needed to separate the organs and restore their integrity.

Output

Treatment of ulcer penetration is always surgical.

Penetration is a dangerous complication of peptic ulcer disease. With it, there are violations of the integrity of not only the stomach, but also the neighboring organ, where the ulcer penetrates. A severe inflammatory process develops.

The main reason for its formation is a negligent attitude towards one's health, non-observance of the regime of work and rest, and improper nutrition. Most often, penetration occurs with the rapid progression of peptic ulcer disease, but it can also be a complication of stomach cancer. Therefore, in order to prevent the appearance of a serious complication:

• The ulcer should be treated in a timely manner and with adequate methods.
• At the first sign, contact a gastroenterologist, and not wait for everything to pass by itself.
• In no case should you treat yourself.

There are many reasons for the formation of an ulcer, and they can be eliminated after a full diagnosis with complex treatment.

The formation of a defect in a neighboring organ or penetration of a stomach ulcer causes the development of severe pain, which can provoke painful shock and a sharp drop in blood pressure. This condition poses a threat to the patient's life due to the likelihood of damage to the peritoneum and the development of peritonitis. The symptoms of penetration depend on the organ in which the perforation occurred, and it can be detected using ultrasound, X-ray and magnetic resonance imaging.

Characteristics of the pathological condition

What it is?

The opening that emerges from the defect in the gastric mucosa and enters the adjacent organ is called penetration. As a result of this process, various organs can be affected. From the ulcer of the central part of the stomach, an opening most often passes into the pancreas or into the buffer formations of the peritoneum. Ulceration of the bile ducts is caused by a lower ulcer.

Complications with the penetration of a stomach ulcer are associated with damage to nearby organs.

What could be the reasons?

Pathology spreads to neighboring organs.

The development of pathology is possible if an adhesion process is present in the human body, which contributes to a closer proximity of organs, and sometimes full contact with the region of the stomach where the ulcer is located. A long-term current inflammatory process provokes the formation of a through defect, and the ingress of contents into a nearby organ. At the same time, the close location of one of the functional particles of the body does not allow it to enter the abdominal cavity. However, the aggressive effect of food particles and hydrochloric acid provokes the formation of an ulcer defect in it.

Thus, the main reasons for the development of ulcer penetration can be identified:

• the presence of an adhesive process;
• long-term ongoing stomach or duodenal ulcer;
• a small area of \u200b\u200bthe ulcer, which prevents the contents from entering the abdominal cavity with the formation of peritonitis.

Penetration stages

The ulcer damages the epithelial cells, provoking the appearance of adhesions.

The formation of an ulcer or erosion in a neighboring organ in the process goes through the following degrees of development:

• First stage. Prolonged course of a mucosal ulcer with the formation of a focus of chronic inflammation.
• Second degree. Due to the long current inflammatory process adhesions are formed, which causes the ulcer to fix with a neighboring organ.
• Stage Three. Complete perforation and ingress of hydrochloric acid and food particles outside the stomach.

Symptoms of pathology

A penetrating ulcer of the stomach and duodenum provokes the occurrence of such unpleasant manifestations, as:

• long-term current pain syndrome with predominant localization in the epigastric region;
• an increase in body temperature, sometimes slight;
• sharp intense pain at the site of perforation, which can provoke painful shock.

The presence of bile indicates damage to the pancreas.

The peculiarities of the symptoms of penetration depend on the organ in which the perforation occurred. If the formation of a hole has occurred in the pancreas, then in a person, in addition to sharp pain, drops appear blood pressure... Hiccups, nausea and vomiting with an admixture of bile are also possible. Stool disorders (diarrhea or constipation) are common, and skin become cyanotic. With the penetration of the bile ducts, the body temperature rises significantly up to 40 degrees. There is significant sweating, intoxication and disturbance general condition... Consciousness and shock may develop. Sometimes signs appear obstructive jaundice due to a violation of the outflow of bile. Perforation of the intestine is characterized by a feeling of fullness of the abdomen and false urge to defecate.

Complications

The danger with perforation of a stomach or duodenal ulcer is damage to the organ in which the perforation occurred. In this case, its function can be significantly impaired. Strong pain leads to the development of severe pain shock with a sharp drop in blood pressure. In the case of an untimely diagnosis of the pathological condition, gastric contents may enter the peritoneum with the development of peritonitis. This disease is very dangerous and, if untreated, causes death throughout the day.

Diagnostics of the penetration of stomach ulcers

Using a fibrogastroscope, you can examine the upper gastrointestinal tract and make a sampling of the affected tissue for research.

It is possible to detect penetration in peptic ulcer disease using methods such as:

• fibrogastroduodenoscopy;
• x-ray of the stomach with contrast;
• ultrasound diagnostics;
• magnetic resonance imaging and computed tomography;
• general blood analysis;
• laparoscopy.