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Gastric Perforation ( stomach perforation) is a full-thickness injury of the wall of the stomach. Severe untreated gastritis or chronic ulcerations are the most common cause of perforations. Perforations occur acutely. There is a sudden onset of abdominal pain and in some extreme cases severe sepsis-like symptoms.
Gastritis or gastric ulcers are the most common cause of stomach perforation. It occurs most commonly in elderly patients taking over-the-counter pain medications mostly NSAIDs and in patients consuming excess alcohol. There are various other causes that can lead to stomach perforation which include trauma, cancer, and iatrogenic. Here we discuss a case of a young patient with severe sepsis and gastric perforation.
Severe sepsis and perforation of hollow viscus is an acute emergency. Time is of the essence. Prompt diagnosis and appropriate management is the key to the best outcome. A young adult presented to the emergency department with sudden onset of pain and distension of the abdomen. He was very well by himself apart from mild gastritis-like pain for over a period of one month. He has been taking on and off treatments without consulting a specialist and has been avoiding seeing a physician because of his work pressure. He one day woke up with severe abdominal pain fever and chills that brought him to the emergency room.
During this visit, he was immediately recognized to be in septic shock and was immediately admitted and appropriate antibiotics and intravenous fluids were started. He was resuscitated well and during this time he underwent computed tomography which showed hollow viscus perforation more likely due to gastric perforation. The diagnosis was made after careful and close evaluation of the investigations by MH Surgery Clinic Surgeons.
During the surgery, there was severe intraabdominal infection and pockets of pus collection. On careful evaluation, there was a large gastric ulcer that was perforated. The area of the ulcer was cleaned and sutured using a modified Graham patch technique. The entire abdomen was washed thoroughly of any fluid collections. All this was performed by our surgeons at our Complex Surgery Center. The patient was managed in the intensive care unit for few days. The patient recovered extremely well and remained with significant low pain and was discharged home.
Gastric perforations are not uncommon. Though the incidence has decreased a careful history is important in evaluating patients with sudden onset of severe abdominal pain. Surgeons should evaluate about prior bouts of abdominal or chest pain, prior instrumentation (nasogastric tube, endoscopy), prior trauma, prior surgery, malignancy, possible ingestion of foreign bodies, medical conditions (PUD) and medication (NSAIDs, glucocorticoids) to arrive at a proper diagnosis. Our Surgeons at Complex Surgery Center at MH Surgery Clinic are well trained in managing such complex situations where prompt diagnosis and management can save future morbidity and mortality to patients.