What is penetration and perforation of ulcers?

Penetration and perforation are complications of an ulcer in the stomach or upper intestines. An ulcer is a sore on a tissue surface that causes the layers of tissue to break down. When an ulcer makes a hole in 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 ulcers are severe and life-threatening if not treated.

How does it occur?

Ulcers can develop slowly over a period of months, or rapidly, in a few days. Normally, food is broken down into small particles by the acid produced in your stomach. An ulcer occurs when this acid also breaks down the wall of the intestines or stomach. This can happen when too much acid is produced or when the protective mucus layer that lines the stomach and intestines is reduced. Taking anti-inflammatory drugs (such as aspirin) or drinking alcohol are ways in which you may reduce the mucus layer.

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

• tarry or bloody stool.

The symptoms of a penetrating ulcer include:

• pain that radiates into the back

• distress at night

• little relief from food or antacids (for example, Maalox)

• fever.

How is it diagnosed?

To see if your ulcer has penetrated or perforated, the doctor may do a blood test and urine analysis. The doctor may also do liver function tests. If your ulcer has penetrated or perforated you will be hospitalized. Surgery may be necessary to examine the inside of your abdomen and pinpoint the problem areas.

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 to restore your blood volume. Surgery will probably be done to close the hole. If the ulcer has penetrated into other organs, the doctor may have to do more surgery.

It is best to discuss self care and ongoing treatment with the doctor, since ulcers can occur again.

You are kept under close observation in the hospital. The doctor may use a procedure called nasogastric suction to remove the contents of the stomach by a tube in the stomach. Further treatment might include:

• medications that reduce the amount of acid your stomach produces or to coat the healing area

• a liquid diet for 24 hours, followed by soft foods and then a regular diet, depending on how well your body can tolerate it

• antacids 1 and 3 hours after meals and at bedtime

• antibiotics to treat infection

• drugs to help you rest and sleep.

How can I take care of myself?

To help take care of yourself, follow the treatment the doctor prescribes. In addition, you can:

• Avoid smoking.

• Avoid alcohol.

• Avoid taking aspirin and anti-inflammatory drugs such as ibuprofen.

• Avoid coffee and any particular foods that bother your stomach.

• Eat small, frequent, healthy meals, following the diet prescribed by the doctor.

• Get plenty of rest and sleep.

• Exercise regularly.

How can I prevent an ulcer from penetrating or perforating?

Follow the treatment the doctor prescribes, including taking all of your medications. Stress and anxiety cause the ulcer to last longer and possibly recur. To reduce the chance of recurrence follow these lifestyle changes:

• Learn to use relaxation techniques, such as deep breathing exercises.

• Keep a positive attitude about yourself, your life, and your surroundings.