Complications of the ulcer disease of the stomach and duodenum (perforation, penetration, malignization)

Complication ulcer disease Stenosis(10%) Bleeding (20%) Perforation (10%) Malignization (0,3-15%) Penetration (5%)

Classification of the ulcer perforations (B.D.Komarov, V.S.Savelev) Localization Clinic currency А) in the stomach By small curvature Anterior wall Posterior wall Cardial zone Pyloric zone B) In the duodenum А) perforation into the free space, into the abdominal cavity B) Hidden perforation C) Perforation with the atypic currency

Main signs of the perforation of the ulcer (Mondor’s triad) 1. Dagger pain 2. Board abdomen 3. Presence of the ulcer anamnesis The board abdomen defines at the palpation

Ways of the spreading of pain at the prforation of the UDS and duodenum Epigastria Right lateral channel Right iliac area Pelvis Left iliac area 1 2 At the ulcer perforation the clinic of the spreading of the pain is similar with the clinic of acute appendicitis (Cocher-Volkovich symptome). 3 5 4

Free gas under the dome of the diaphragm (Spijarskiy symptome ) Overview X--ray

Differential diagnostis Acute appendicitis - laparosopy Acute cholecystitis – US, X-ray Acute oancreatitis – US, diastasa Intensification of the UDS an duodenum – X-ray, EGDFS Acute mesenterial thrombosis - laparoscopy Acute inferct - ECG

Choose of the method of the operation at the perforation of the ulcer Stage of the fermentative desinteration Stage of the festering peritonitis Radical operation Palliative operation Resection TV+ antrumectоmy Sewing of the prforative ulcer TV+ pyloroplastic

Sewing of the perforative ulcer

Resection of the stomach – radical operation at the perforations of stomach an duodenum

Stages of sewing – the first prick

Stages of the operation- tampon to the perforated ulcer

Penetration – passing of the ulcer onto the nearest organs Pancreas Liver Gall bladder

Stages of the penetration 1 stage (39-51%) – defeat with the ulcer process all layers of the stomach or duodenum 2 stage (25-30%) – fibrous connection with the nearest organs 3 stage (22-29%) – the fundus of the ulcer is the parenchima of the nearest organ

Symptoms of the penetration of the ulcer Constant pain in the epigastria with the increasing Irradiation of the pain depend on the organ, in which the penetration was: to the lumbar area (pancreas), to the scapula (liver), to the neck (gall bladder) Not effective conservative therapy At the penetration into the hollow organ the fistula appears.

Method of sewing of the cult at the penetration

Malignization – regeneration of the ulcer into the cancer The ulcer of stomach maligns in 20% cases The ulcer of the duodenum maligns in 0,3% cases States at which the risk of malignization is high: diameter of ulcer more than 1,5 sm, At the localization of ulcer in the stomach, At the patients elder than 40 years, Not effective conservative therapy during 4-6 months.

ULCUS-TUMOR

Signs of the malignization at X-ray Defect of filling, Convergention of the pleats Absence of the peristaltic around the ulcer Defect of filling (finger pressing in)

Gastrectomy