Complications after mending of perforated ulcer

When perforated gastric ulcer in order emergency often made life saving operation closing perforated holes.
Immediate results after this operation, according to the materials of the Institute. N. Century Sklifosovsky (Moscow), should be recognized in a significant percentage of cases satisfactory. In the localization of perforated ulcer in the initial part of the duodenum or preprocessor division stomach often after mending ulcer occurs relative narrowing of the duodenum and stomach, complicating the process of transition of food from the stomach to the duodenum. This fact causes the necessity of forced imposition unloading anastomosis of the stomach with a loop jejunum (gastroenterostomy).
For examination of patients in remote terms after mending of perforated ulcer of the stomach good results in decreased to 0, satisfactory to 7.7%, and poor grew to 92.3%. Unsatisfactory results in the long term after closing of perforated ulcer caused by a number of reasons. Among them the most important is recurrent ulcer light period after, or in place of closing, or outside of this zone, penetrating ulcers. You may experience of cancer in place protection of perforated ulcer. This complication occurs in 2-3% of perforated ulcers and usually occurs after perforation kallusnykh ulcers. The time between suturing of perforated ulcer and cancer in place it may be different - from several months to several years. Sometimes after mending there are late gastroduodenal bleeding profusely.
In the long term after considering surgery may develop deformation of the stomach: the location ulcers in the field of gatekeeper, together with the narrowing of the output from the stomach, sometimes eccentric position gatekeeper in relation to the duodenum. Both of these complications violate evaquatornuu the stomach. In this group of patients may have a feeling of heaviness in the stomach, frequent vomiting, belching rotten, pain in the abdomen.
Perigastric, peridotite are also frequent complication in the remote periods after operation. One of the reasons of developing these complications is trapped food particles into the abdominal cavity at the moment of ulcer perforation. True, and the operation on abdominal organs often leads to the development of perivisceral. All the complications of perforated ulcer of stomach and duodenal ulcers can be divided into two groups:
1. Complications caused by the plague: recurrent ulcer, unhealed ulcer, new plague, penetration ulcers, bleeding from ulcers, re-perforation, ulcers, polyps of stomach cancer in place sewn ulcers.
2. Complications associated with the surgery: stenosis of the output section of the stomach or the initial part of the duodenum, the deformation of the stomach, perigastric and peridotite, gastro-duodenitis, diverticula of the duodenum and stomach (I. I. Neimark, 1958).
Despite some shortcomings, the above classification is useful, as it helps to better understand the pathogenesis of late complications after mending of perforated ulcer. All late complications after mending of perforated ulcer of stomach and duodenal ulcers caused by ulcers, be first to conservative treatment, and at the failure of the last re-operation - gastrectomy. As for complications associated with the surgery, part of complications subject surgical treatment: stenosis, deformation of the stomach, diverticula of the stomach and duodenum, and others - therapy and physiotherapeutic treatment (gastroduodenitis, perigastric and peridotite).
Gastroenterostomy as the basic operation when ulcers stomach and duodenal ulcers currently rarely used, since mass experience of using it for over 30 years discredited her: soon after the imposition of anastomosis many patients is a considerable relief, and then a large portion of the symptoms of peptic ulcer disease recurs, and even a new syndrome called "gastroenterostomy as a disease" (Pribran, 1923). In the basis of development of the symptom complex lies the activity of gastric juice in the mucous membrane of intestine and often the development of peptic ulcer at the site of anastomosis or near it. Patients complain of constant empty eructation, a heartburn, and occasionally vomiting, pain under the spoon, especially after eating.
Clinically and radiologically syndrome of gastrojejunostomy is very close to that in the duodenal the stasis observed in organic changes in the duodenum and outside, creating difficulties for her discharge.
Research, L. Shapiro (1951) established that the distribution and intensity of the most common forms of "diseases of operated stomach" - gastroente is dependent on the degree of trauma to the nervous apparatus of the body.
It is advisable to consider individual early and late complications after operations on the stomach.