Penetration and Perforation of Ulcers

What is penetration and perforation of ulcers?

Penetration and perforation are complications of an ulcer in the stomach or upper intestine. An ulcer is a sore on a tissue surface that causes the layers of tissue to break down. When an ulcer makes a hole through the tissue it is called perforation. When an ulcer spreads to other nearby organs or tissues it is called a penetrating ulcer. These two types of ulcer complications are severe and life threatening if they are not treated.

How does it occur?

Ulcers occur when an area of the lining of the stomach or intestine is eaten away by stomach acid and digestive juices. The linings of these organs are normally protected from stomach acids. However, under certain conditions the protection fails and ulcers can result.

Common causes of ulcers are:

• a type of bacteria called Helicobacter pylori, also called H. pylori
• long-term use of anti-inflammatory medicines, such as aspirin, ibuprofen, and naproxen.

Ulcers occur more often in people who smoke cigarettes. Other substances that increase the production of stomach acids, such as caffeine, may increase the risk of ulcers and are known to worsen the pain. Stress has been thought to contribute to ulcers, but its role in causing ulcers is not clear.

Ulcers can develop slowly for months or rapidly in a few days. When an ulcer worsens, it can penetrate into organs such as the pancreas and liver, or into the abdominal wall.

What are the symptoms?

The symptoms of perforating ulcer include:

• sudden severe upper abdominal pain
• extreme tenderness of the upper abdomen
• loss of color in the face
• weakness
• chills
• fast, shallow breathing
• fast heart rate
• dizziness
• bowel movements that are black and tarry bowel or bloody.

The symptoms of a penetrating ulcer include:

• pain that radiates into the back
• pain that gets worse at night
• little pain relief from food or antacids (for example, Maalox)
• fever.

How is it diagnosed?

Ulcer complications can be emergencies. Your healthcare provider will ask about your symptoms and do a physical exam, especially of your abdomen. You may have one or more of these tests:

• lab tests of blood and urine samples
• X-rays
• upper endoscopy, a procedure that allows your provider to see the ulcer with a thin flexible tube and tiny camera inserted through your mouth down into your upper digestive tract.

How is it treated?

If the ulcer has made a hole all the way through the tissue, it causes bleeding inside the abdomen. If you are bleeding inside, you will be hospitalized and given emergency treatment for blood loss. You will have surgery to close the hole.

You will be closely observed while you are in the hospital. You may have a tube from your nose to your stomach to suction and remove the contents of your stomach. Further treatment may include:

• medicines that reduce the amount of acid your stomach makes or coat the healing area
• when you are able to eat again, a liquid diet for 24 hours, followed by soft foods and then a regular diet, depending on how quickly your stomach heals
• antacids 1 and 3 hours after meals and at bedtime
• antibiotics if you have an infection
• pain medicine.

How long will the effects last?

The length of your recovery will depend on your condition at the time of surgery, how difficult your surgery was, and whether you had any complications. In most cases you should feel a lot better by the end of 2 to 3 weeks. However, it is likely to take at least 6 weeks before you completely recover from the surgery and begin to have your normal level of strength and energy.

How can I take care of myself?

• Follow the full treatment prescribed by your healthcare provider. Keep your follow-up appointments.
• Do not smoke cigarettes.
• Avoid taking anti-inflammatory drugs such as aspirin, ibuprofen, and naproxen.
• You may want to make other lifestyle changes such as:
  • Eating healthy meals. Several small meals may be better than 2 or 3 large ones. Follow the diet prescribed by your healthcare provider.
  • Avoiding coffee, including caffeinated and decaf coffee, colas, and any other food or drink that may bother your stomach, such as alcohol.
  • Getting plenty of rest and sleep.
  • Exercising as recommended by your provider.
• If you keep having symptoms or your symptoms get worse, tell your provider.

How can I help prevent an ulcer from penetrating or perforating?

• Follow the treatment your healthcare provider prescribes, including taking all of your medicines.
• Ask your healthcare provider if you need to take medicine to prevent new ulcers.