Gastric perforation

Gastric perforation is most commonly seen in gastric ulcers, being the most serious complication of ulcer disease and one of the most common acute abdominal conditions in general surgery, often occurring on the lesser curvature of the anterior wall of the gastric antrum. The incidence of ulcer perforation is 5% to 10% of all ulcer cases, accounting for about 20% to 30% of ulcer disease hospitalizations, with perforation combined with bleeding accounting for about 10%. Clinically, acute perforation is more common, and the incidence of acute perforation of duodenal ulcers is higher than that of gastric perforation, accounting for about 90% of all acute ulcer perforations, commonly seen in young adults, mostly occurring on the anterior wall of the duodenum. Gastric perforation is more common in middle-aged and elderly people over 50 years old, with a small number of patients having gastric cancer perforation. Perforation has a seasonal pattern, with the highest occurrence in winter. Most patients have a long history of ulcer disease and recent exacerbation, but about 10% of patients have no clear ulcer history. Improper diet, emotional changes, and other factors can trigger its occurrence. On X-ray examination, about 75% to 80% of cases show crescent-shaped free gas under the diaphragm. Subdiaphragmatic free gas is an important piece of evidence for the diagnosis of gastric perforation. The clinical course of ulcer perforation can be divided into three stages. The principle of treatment for gastric perforation is to perform surgical treatment as soon as possible. Delayed treatment, especially beyond 24 hours, significantly increases mortality and complication rates and prolongs hospital stay. For small perforations on an empty stomach, short perforation duration, mild clinical manifestations, localized peritonitis signs, or when the diagnosis is not yet clear, non-surgical treatment with close observation may be attempted first. For the prevention of this disease, patients with gastric and duodenal ulcers should undergo early gastroscopy screening to determine the nature, location, and severity of the ulcer, and receive timely systematic medical treatment.