Perforated Ulcer

What is a perforated ulcer?

A perforated ulcer is a raw place or sore in the lining of the stomach or upper intestine that makes a hole through the tissue in the stomach or intestine. If an ulcer spreads to other nearby organs or tissues it is called a penetrating ulcer. These problems are severe and life threatening if they are not treated.

What is the cause?

The lining of the stomach and intestine normally keeps these organs from being hurt by stomach acid and digestive juices. If this protective layer breaks down, stomach acids can damage the walls of the stomach and intestine and cause an ulcer. You may get an ulcer when:

• You have bacteria called Helicobacter pylori (H. pylori). These bacteria are the most common cause of ulcers. When H. pylori bacteria infect the stomach or intestine, the infection can weaken the lining of these organs so stomach acid can reach the stomach or intestinal wall and damage it.
• You regularly take nonsteroidal anti-inflammatory drugs (NSAIDS), such as aspirin, ibuprofen, and naproxen. These medicines irritate the lining of the stomach and upper intestine, making it easier for stomach acid to damage the lining.
• Your stomach makes too much stomach acid.

Ulcers can develop slowly for months or quickly in a few days. Sometimes ulcers get worse and penetrate through the stomach wall and into organs such as the pancreas and liver.

What are the symptoms?

The symptoms of a perforating ulcer include:

• sudden sharp pain in the upper belly or extreme tenderness in the upper belly that doesn’t go away
• loss of color in your face
• weakness
• chills
• fast, shallow breathing
• fast heart rate
• feeling like you’re going to faint
• bowel movements that are black and tarry or bloody

The symptoms of a penetrating ulcer include:

• pain that travels to the back
• pain that gets worse at night
• pain that is not relieved by eating food or taking an antacid (for example, Maalox)
• fever

How is it diagnosed?

Your healthcare provider will ask about your symptoms and examine you, especially your belly. You may have 1 or more of these tests:

• lab tests of blood and urine samples
• X-rays
• CT scan
• upper endoscopy

Upper endoscopy is a procedure that lets your provider see the ulcer with a long, flexible tube and tiny camera put into your mouth, down your throat, and into your stomach and intestine. It also lets your provider to see if there is bleeding inside your belly.

How is it treated?

If the ulcer has made a hole all the way through the tissue, it will cause bleeding inside the abdomen. You will need to stay in the hospital. You may be given emergency treatment for blood loss, and you will have surgery to close the hole.

You will be closely observed while you are at the hospital. You may have a tube from your nose to your stomach to suction the stomach. This rests the stomach by keeping it empty. It also helps your healthcare provider know if the bleeding has stopped.

Other treatment may include:

• medicines that reduce the amount of acid your stomach makes or that coat the area needing to heal
• antacids to neutralize the acid in your stomach
• antibiotics to prevent or treat infection
• pain medicine

When you are able to eat again, you will have a liquid diet for 24 hours or longer. Then you will eat only soft foods until your stomach has healed enough for you to go back to your regular diet.

You will need to avoid alcohol, cigarettes, and chewing tobacco because they slow the healing of ulcers.

The length of your recovery depends on your condition at the time of surgery, how difficult your surgery was, and whether you have any complications, such as more bleeding or infection. In most cases you should feel a lot better in 2 to 3 weeks. 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. Take your medicines exactly as your healthcare provider told you to. Keep all follow-up appointments.
• Follow the diet prescribed by your healthcare provider. Avoid any food or drink that seems to bother your stomach, such as spicy foods; oranges and other citrus fruits; and tea, coffee, and cola.
• Avoid alcohol, cigarettes, and chewing tobacco because they slow the healing of ulcers.
• Ask your provider if you should avoid drugs that irritate the stomach, such as aspirin, ibuprofen, and naproxen. If your provider says it’s OK to take these drugs, try taking them with food to help avoid irritating your stomach. These drugs may cause stomach bleeding and other problems. These risks increase with age. Read the label and take as directed. Unless recommended by your healthcare provider, do not take these drugs for more than 10 days for any reason. Ask your provider if you can use acetaminophen for pain relief instead.
• Get plenty of rest and sleep.
• Exercise as recommended by your provider.
• Do things to help your mood and emotions. If stress is a problem for you, talk to your provider about your feelings.
• Ask your healthcare provider:
  • how and when you will hear your test results
  • what activities you should avoid and when you can return to your normal activities
  • how to take care of yourself at home
  • what symptoms or problems you should watch for and what to do if you have them
• Make sure you know when you should come back for a checkup.