Complications of gastric ulcer. Penetration of a stomach ulcer: causes, what symptoms are manifested and how to treat What is ulcer penetration

Penetration of a stomach ulcer is the process of penetration of a pathological formation into nearby organs. As a result, the fibrous tissues are fused and the two organs are connected.

At the initial stages, it leads to the occurrence of constant pain and a deterioration in the general well-being of a person. If untreated, very serious life-threatening complications are possible.

Causes

Penetrating stomach ulcers and 12 duodenum manifest as heavy. The main reasons for the development of pathology are directly related to the presence of progressive ulcers on the gastric mucosa.

The deeper the layers of the walls of the digestive organ are affected, the higher the risks of penetration of ulcerative formation into the organ adjacent to the stomach. Ulcer penetration occurs more often if there are adhesions between the individual organs in the upper abdomen.

Typically, a penetrating ulcer on the stomach wall or duodenum has a small size - up to one and a half centimeters. Pathology always arises against the background of an inflammatory process, which can be caused by various factors, for example:

• Non-compliance with the diet.
• Stress and nervous strain.
• Bad habits.
• Uncontrolled reception drugs.

Symptoms

Penetration of gastric and duodenal ulcers may manifest itself various symptoms depending on the severity of the complication and the organ that is involved in the pathological process.

Most often ulcers penetrate into the pancreas. In this case, sharp painwhich can cause shock. Other symptoms overlap with those of acute pancreatitis:

• There are jumps blood pressure.
• or constipation.

When a penetrating ulcer affects the intestines, severe pain may occur in the navel area. This often occurs:

• Vomiting mixed with bile.
• Heaviness in the abdomen.
• Heartburn and belching.
• False urge to defecate with constipation.

With the defeat of a penetrating ulcer of the bile ducts, a sharp increase in temperature is always observed and severe pain occurs in the area of \u200b\u200bthe right hypochondrium. In addition, all the signs of intoxication are present. Over time, jaundice of the skin appears, and in severe cases, loss of consciousness occurs.

Penetration of the ulcer into the liver is accompanied by pronounced weakness and. In this case, the pains that begin in the right hypochondrium quickly spread to the entire abdomen. There are also signs of liver inflammation: jaundice occurs and darkening of urine is observed.

Stages

At the first stage of the development of pathology, a slight ulceration occurs, affecting the walls of a nearby organ, and a spike is formed. Against the background of a prolonged inflammatory process, an increasing fusion of the tissues of the two organs occurs, and this indicates that the disease has passed into the second stage.

Further, if measures are not taken or when the treatment does not give a positive result, tissue destruction begins and the ulcerative formation affects another organ. At the third stage of stomach disease, penetration occurs.

Deformation of tissues of another organ and their destruction indicates the fourth stage of the development of the disease. This period is associated with, as well as the appearance of other symptoms that indicate the development of a serious complication.

Stop inflammatory process it is very difficult to penetrate the ulcer. The contents of the stomach begin to penetrate into the adjacent organ and cause tissue edema and further destruction.

Diagnostics

Diagnosis of developing complications associated with ulcer penetration is sometimes difficult due to the fact that the symptoms coincide with those of many other diseases. Due to this, only a comprehensive examination of the patient can clarify the clinical picture.

First, upon confirmation of availability peptic ulcer the doctor must examine the patient and collect an anamnesis of the disease. He specifies in which zones and when the pain, as well as where the pain radiates. The following laboratory tests and instrumental studies are used to make a diagnosis:

• General blood analysis. It is very important in it eSR indicator, which, when increased, indicates the development of inflammation.
• Fibrogastroduodenoscopy. In this way, you can investigate the existing ulcer and determine the depth of its crater.

• Fluoroscopy. It allows you to detect an increase in the depth of the ulcer and fix the limitation of its mobility.
• Laparoscopy. With the help of this study, it is possible to visualize the attachment of the ulcer formation to another organ.
• Ultrasound allows you to examine all organs of the abdominal cavity for changes in their structure due to the penetration of the ulcer.

Treatment

Penetrating ulcers are difficult to treat conservatively. It is possible to slow down the progression of the pathological process by conservative methods only at the initial stage of development. carried out exclusively in a hospital, since gastroenterologists must be sure to monitor the patient's condition around the clock.

Mandatory for conservative treatment a penetrating ulcer is necessary. Its purpose is to reduce the load on the digestive tract. The diet includes only light food, which should be eaten often, but in small portions.

Advice! During the treatment of a penetrating ulcer, bad habits.

When the condition worsens or when the disease has reached the third stage, a complex operation is performed. Sometimes surgical treatment involves resection of 2/3 of the stomach and part of the organ where the ulcer penetrated.

Medicines

Conservative methods of treatment can be used only if there has been no deformation of the organ that is affected by the inflammatory process. Drug therapy involves taking the following means:

• Drugs that stimulate gastric motility.
• Antacids that reduce acidity.
• Medicines that promote tissue regeneration.

Taking medications for early stages able to slow the progression of the disease. With good immunity, if all medical recommendations are followed, tissue scarring can begin. But at the same time, the process of treatment with conservative methods is always very long.

Folk remedies

Folk remedies after confirming the diagnosis of a penetrating ulcer cannot become the main remedies... They can only be used as an additional treatment.

Many have a healing effect. Therefore, their use in the treatment of peptic ulcer disease is fully justified. There are a lot of folk recipes, the effectiveness of which has been confirmed by time. But it should be remembered that before you start using such funds, you must definitely consult a doctor.

Forecast

If a penetrating ulcer was diagnosed at 1-2 stages of development, the prognosis is almost always favorable. Through conservative methods treatment and adherence to a strict diet usually stops the pathological process. But it should be understood that it will take a long time to heal the ulcerative lesion.

When diagnosing a disease of 3-4 degrees, a positive prognosis is only possible. In this case, it is very important that appropriate rehabilitation is carried out after the operation. For a long time, you need to be very careful about your health so that complications do not arise, in particular, stomach cancer.

Penetrating gastric ulcer is a very serious illness, but it can be defeated with the right attitude. In addition to complying with all medical prescriptions, it is necessary to give up bad habits, avoid stress and lead a correct lifestyle, in which there must be a place for good rest.

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 an ulcer in 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 an ulcer in the lower sections.

Complications during the penetration of gastric ulcers 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 go into 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 chronic inflammation.
• Second degree. As a result of the long-term current inflammatory process, the formation of adhesions occurs, 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 features 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, there are drops in 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 impairment general condition... Consciousness and shock may develop. Sometimes signs appear obstructive jaundice due to a violation of the outflow of bile. For intestinal perforation, a feeling of distention of the abdomen and a false urge to defecate are characteristic.

Complications

The danger of 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 a 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.

Ulcer penetration is considered a rather dangerous complication of this disease. This problem is diagnosed in about 10-15% of cases of peptic ulcer disease, and men 40 years old who have a long history of pathology are more susceptible to it. As a rule, this disease is caused by the development of an inflammatory process in a chronic ulcer.

Penetration is the penetration of an ulcer into other organs. So, the defeat of the duodenal bulb usually extends to the pancreas. More rarely, it affects the bile ducts or liver. Even less often, this problem is localized in the large intestine. Mediogastric ulcers usually involve the pancreas. Sometimes the small omentum suffers.

Causes

Penetration usually develops when the following conditions are present:

1. Ulcerative defect. The deeper the layers of the stomach are affected, the higher the risk of developing such complications.
2. Adhesions in the upper abdomen. It is this problem that leads to close contact of adjacent organs and reduces the likelihood of their distance from each other.

In this case, the development of a penetrating ulcer has the following mechanism:

1. As the gastric ulcer progresses, the defect affects all layers of the organ. Moreover, its area may not be too large - the diameter, as a rule, is 1-1.5 cm.

In this issue, the key role is assigned to the amount of gastric juice. An excess of this substance flows out through a special hole, which as a result provokes perforation, shock and even death. If the diameter is less important, the juice does not come out, and therefore the likelihood of shock is minimal.

1. As the peptic ulcer progresses, the adhesive process develops. This problem due to the ingress of gastric contents into the cavity. As a result of this process, inflammation develops, which leads to the appearance of adhesions. As a result, the stomach is attached to nearby organs. This process can be of a different nature - it all depends on the location of the ulcer.
2. After the attachment of organs to the stomach, its contents do not enter the abdominal cavity. In this case, a certain organ suffers, which leads to the appearance of a characteristic clinical picture.

Stages

On initial stage the disease progresses a chronic inflammatory process, as a result of which there is a partial destruction of the stomach wall. From the outside, adjacent organs adjoin the area of \u200b\u200blocalization of the ulcer.

The second stage is characterized by severe damage to the layers of the wall of the diseased organ. But the pathological process has not yet left its limits. In this case, there is no damage to the wall of another organ. The formation of dense adhesions occurs between it and the stomach. If they collapse, a through defect appears in the wall.

In the third stage, the layers of the stomach are completely destroyed. Ulcerative lesion affects the adjacent organs, which provokes the appearance of a minor flat defect. In this case, the structure of the penetrated organ is disrupted, which is located in the circumference of the ulcer. It becomes denser, sclerotic processes are observed. In addition, severe deformity of the stomach is characteristic.

The fourth stage is characterized by the formation of deep cavities in a nearby organ. In the penetration zone, a tumor formation of an inflammatory nature is formed.

Symptoms

This type of disorder is characterized by the appearance of the following symptoms:

1. Pain syndrome in the epigastrium. Discomfort becomes permanent and pronounced, loses its daily rhythm and is not associated with food.
2. Typical localization of pain. This condition depends on which organ is affected. So, when an ulcer spreads to the pancreas, the pain syndrome usually radiates to the right lumbar zone, sometimes to left side... Often, discomfort is also felt in the back or the pain becomes girdle.When the lesser omentum is affected, discomfort is felt at the top on the right side - the pain can affect right shoulder or the collarbone. If the ulcer is located high enough, the pain syndrome can affect the heart. If the postbulbar ulcer spreads to the mesentery of the large intestine, the discomfort is sent to the navel.
3. Local soreness. Intense pain syndrome often occurs in the projection of penetration. In addition, this violation is often accompanied by the appearance of an inflammatory infiltrate.
4. Signs of damage to certain organs. Clinical picture depends on which organ the ulcerative defect extends to.
5. An increase in temperature to subfebrile values.

Diagnostics

To diagnose the penetration of peptic ulcer disease, the doctor carefully examines the patient's history, conducts a clinical examination and prescribes additional studies - laboratory and instrumental.

When examining the anamnesis, attention is paid to the presence of gastric ulcer or risk factors for its appearance. Loss of connection between epigastric pain syndrome and food intake is of no small importance. Discomfort becomes permanent and radiates to the arms, neck, back.

To make an accurate diagnosis, the following studies are prescribed:

Treatment

Penetrating stage 1-2 ulcerative lesions are difficult to respond drug therapy... If a person is diagnosed with a more advanced form of the disease, the ulcers do not heal at all. In such a situation, the only treatment is considered surgical intervention.

If the patient is diagnosed with a penetrating type 1-2 ulcer, he is carried out. At the first stage of a small ulcerative lesion, vagotomy can be performed, which must be combined with gastric drainage. A similar version of the intervention is carried out when large inflammatory infiltrates appear. They cannot be separated as there is a risk of organ damage.

Forecast

In the absence of adequate treatment, the prognosis is usually poor. This complication of peptic ulcer disease can lead to the development of shock and death. Due to timely surgical intervention, the likelihood of cure increases.

Ulcer penetration is a very dangerous condition in which various organs can be affected. If this pathology is detected, you need to immediately start treatment. In most cases, the only effective method therapy is considered to be surgery.

Ulcer penetration is the penetration of an ulcerative lesion into neighboring organs. There is a penetration of gastric and duodenal ulcers. Erosion is localized mainly in the head of the pancreas, large canals of the gallbladder, liver, hepato-gastric ligament, large intestine.

What is the disease

If we talk in simple words, then a penetrating stomach ulcer is the spread of the inflammatory process to other organs, followed by the formation of erosions.

Penetration stages:

• the spread of erosion in all layers of the walls of the stomach, duodenum 12;
• connective tissue fusion with nearby organs or organ;
• penetration of erosion into organ tissue.

The first stage is characterized by the progression of chronic inflammation in erosion with partial destruction of the walls of the stomach or duodenum. The second stage is characterized by deep destruction the walls of the affected organs.

At the third stage, there is a complete destruction of all layers of the walls of the organ or organs. At the same time, they are subject to deformation.

Development reasons

The main reasons for the development of pathology are the presence of progressive ulcers and a penetrating inflammatory process. That is, if gastritis and gastroduodenitis are not cured in time, then the walls of the stomach or duodenum become covered with ulcers. Later they appear in neighboring organs.

The key role in this is played by the increased production of hydrochloric acid, which is part of the gastric juice. Factors such as unhealthy diet, infection, non-compliance with the rules of treatment provoke excess production of hydrochloric acid.

By acting regularly on the ulcer, the acid causes more and more inflammation. As a result, the layers of the walls of the stomach and duodenum will be affected deeper and deeper. The result is penetration.

Forecast

If there is no adequate treatment, the prognosis is poor. During the formation of ulcers, the replacement of normal healthy tissues with adhesions occurs. This process causes deformation of organs, which can cause narrowing of the lumens, obstruction of food.

These complications of ulcerative lesions lead to the development of shock, often cause death. If timely surgical intervention is performed, then the prognosis is positive. The cure occurs in 99%.

Symptoms of pathology

Symptoms of penetration depend on the stage of the pathology. If the disease has just begun to progress, then the person will feel symptoms characteristic of a peptic ulcer: pain in the stomach, navel (but distinctive feature this pathology - pains are regular, regardless of food intake). Hunger pains during penetration bother a person less often. Later, if any organ is damaged, the disease manifests itself in different ways.

If the ulcer penetrates into the pancreas (head area), then signs of acute pancreatitis appear:

• pain is very intense, cutting, dull (can cause painful shock) - the main symptom;
• heat;
• increase or decrease in blood pressure;
• hiccups, nausea, belching, vomiting (with bile);
• diarrhea or constipation;
• dyspnea;
• cyanosis of the skin.

When the bile ducts are damaged, the following symptoms appear:

• a sharp rise in body temperature up to 38-40 ° C;
• severe sweating, drowsiness;
• intense pain in the right hypochondrium, similar to biliary colic;
• intoxication, expressed by weakness, loss of appetite, headache, nausea, vomiting, diarrhea;
• yellowness of the skin;
• impairment of consciousness (in severe pathology);

Penetration into the intestinal area is manifested by symptoms of duodenitis, colitis:

• feeling of fullness of the abdomen;
• lack of appetite;
• heartburn;
• belching;
• nausea, vomiting with bile;
• false urge to defecate;
• heaviness in the abdomen;
• constipation.

If penetration occurs in the liver, then this condition is characterized by an attack of acute hepatitis:

• nausea;
• weakness;
• pain in the right hypochondrium, spreading throughout the abdomen;
• jaundice;
• darkening of urine;
• itchy skin;
• enlargement of the liver in size;
• weakness, headache.

With penetration in the peritoneal region, the following appears:

• heat;
• weakness, thirst;
• abdominal pain - strong, paroxysmal;
• swelling of the lower back.

Diagnostics and treatment

Diagnostics of penetration includes examination of the patient, identification of symptoms, laboratory and instrumental research.

To establish an accurate diagnostician, the following is assigned:

• delivery of analyzes;
• fibrogastroduodenoscopy procedure;
• fluoroscopy technique;
• laparoscopic examination;
• ultrasound examination.

Treatment of such a pathology is best done surgically... No medicines, dietary supplements and other drugs will help prevent irreversible consequences... Moreover, the earlier the pathology is diagnosed, the more successful the treatment.

Do not forget that any ulcer can cause sepsis, peritonitis after perforation.

In the early stages of the lesion, doctors can still prescribe a course complex therapy, in the event that healthy tissues are not replaced by connective tissue and organ deformation has not occurred. Medicines are also prescribed if the penetration of the ulcer did not entail stenosis, bleeding and other complications.

A medical course of therapy is carried out only in a hospital, since the patient and his standing should be monitored around the clock. When the condition worsens, cardinal methods of treatment are immediately taken. At advanced stages, an operation is performed, in some cases a resection, vagotomy.

To carry out the treatment of peptic ulcer on your own is at least silly not necessary. With the manifestation of the above symptoms, you should immediately induce ambulance or go to the hospital. Penetration is a rather serious complication that can cause irreversible consequences.

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GASTROENTEROLOGY - EURODOCTOR.ru -2005

Penetration - this is the penetration and spread of the ulcer beyond the wall of the stomach or duodenum into the adjacent organs and tissues. The ulcer gradually deepens, reaches the outer lining of the stomach and penetrates the tissue that adjoins the wall of the stomach or duodenum. Ulcers of the body of the stomach penetrate into the lesser omentum or the body of the pancreas. Ulcers of the posterior wall of the duodenal bulb penetrate into the head of the pancreas, liver or biliary tract, the ligament between the liver and stomach. Sometimes, these ulcers penetrate the colon or the mesentery of the colon. Ulcer penetration develops gradually and is difficult to detect.

Allocate three stages of penetration development:

• the stage of the spread of the ulcer to all layers of the wall of the stomach or duodenum
• the stage of connective tissue fusion with a nearby organ. An adhesion-type adhesion develops between the outer shell of the stomach or duodenum and the outer shell of a neighboring organ
• the stage of penetration of the ulcer into the organ tissue.

The patient is worried about pain in the upper abdomen. The nature of the pain is constant, it is not possible to identify any connection with food intake or time of day. Unlike the pain associated with a simple stomach or duodenal ulcer, antacids do not relieve pain.

Often, pain begins to radiate to the organ into which the ulcer penetrates. When penetrating into the pancreas, pain occurs in the back or lower back, and may have a shingles in nature. Occasionally, such pain sensations increase after eating and at night. If the ulcer penetrates the lesser omentum, the pain develops under the right costal arch or radiates to the collarbone, right shoulder, neck.