From the Guidelines
Gastric ulcer rupture is a medical emergency requiring immediate attention, with symptoms including sudden, severe abdominal pain, rapid heart rate, low blood pressure, and signs of shock, and treatment typically involves emergency surgery to repair the perforation, as well as intravenous fluids, antibiotics, and pain management, as recommended by the World Journal of Emergency Surgery guidelines 1. The symptoms of gastric ulcer rupture include:
- Sudden, severe abdominal pain that may radiate to the shoulder
- Rapid heart rate
- Low blood pressure
- Rigid abdomen that feels hard when touched
- Signs of shock such as pale skin, sweating, and confusion
- Nausea, vomiting (possibly with blood)
- Difficulty breathing These symptoms occur when a gastric ulcer erodes completely through the stomach wall, allowing stomach contents including acid and partially digested food to leak into the peritoneal cavity, causing peritonitis, as described in the WSES guidelines for perforated and bleeding peptic ulcer 1. In patients with perforated peptic ulcer, the management involves prompt recognition, resuscitation when required, appropriate antibiotic therapy, and timely surgical/radiological treatment, with a tailored approach based on the location of the ulcer, as suggested by the WSES guidelines 1. The treatment of gastric ulcer rupture typically involves emergency surgery to close the perforation, as well as intravenous fluids, antibiotics such as piperacillin-tazobactam or a combination of ceftriaxone and metronidazole, and pain management, with the goal of preventing sepsis, organ failure, and death, as recommended by the World Journal of Emergency Surgery guidelines 1. In patients with septic shock from a perforated peptic ulcer, a damage control strategy may be suggested, with a staged approach to manage the patient's condition, as described in the WSES guidelines for perforated and bleeding peptic ulcer 1. Non-operative management (NOM) of perforated peptic ulcer may be considered in extremely selected cases where perforation has sealed as confirmed on water-soluble contrast study, but this approach is not routinely recommended, as suggested by the WSES guidelines 1.
From the Research
Gastric Ulcer Rupture Symptoms
- The symptoms of gastric ulcer rupture are not explicitly stated in the provided studies, but complications of peptic ulcer disease, which includes gastric ulcers, can include bleeding, perforation, and pyloric obstruction 2.
- Perforation, which can be considered a rupture, occurs in approximately 9% of patients with peptic ulcer disease 2.
- A study on emergency spontaneous gastric perforations, which can be caused by gastric ulcers, found that the condition has a wide hospital mortality range and can be fatal 3.
- The management of peptic ulcer acute bleeding, which can be a symptom of gastric ulcer rupture, requires prompt assessment, evaluation for early endoscopy, initiation of pharmacotherapy, and treatment of co-morbid diseases 4.
Diagnosis and Treatment
- Endoscopy is used to definitively diagnose peptic ulcer disease, which includes gastric ulcers 2.
- Acid blockers, such as omeprazole, can heal peptic ulcers in approximately 80% to 100% of patients within 4 weeks, but gastric ulcers larger than 2 cm may require 8 weeks of treatment 2.
- Eradication of H pylori and discontinuing NSAIDs can reduce recurrence rates of peptic ulcer disease 2.
- Proton pump inhibitors, such as omeprazole, are the primary treatment for peptic ulcer disease and can reduce recurrence rates 5.
Complications and Mortality
- Peptic ulcer disease, which includes gastric ulcers, is associated with increased hospitalization rates and mortality, with approximately 10,000 people dying of the disease annually in the US 2.
- The rate of emergency ulcer surgery has risen by 44% over the past 3 decades, making it a significant concern for gastrointestinal surgeons 6.
- Gastric perforation due to gastric carcinoma has a high mortality rate and can be difficult to diagnose without a pathologist 3.