Perforated ulcer and its complications

Perforation in the free abdominal cavity could come with a fresh and chronic stomach ulcer and duodenal ulcer. Suspected perforation x-ray examination is performed without the use of contrast mass. Gas falling from the stomach or duodenal ulcer in the case of perforated ulcers, accumulates under the dome of the diaphragm, creating pneumoperitoneum (Fig. 103). In such circumstances, the gas going up, appears between the liver and diaphragm, and under it can be determined horizontal fluid level.

Fig. 103. Pneumoperitoneum after perforation of gastric ulcer (x-ray).
Gas and liquid with a horizontal level between the liver and diaphragm.

Localization perforating holes radiographically to define very difficult, if not impossible.
One of the major complications of perforation is the formation of internal fistula. When perforation of the stomach are formed pistolry turn more often to the colon, with duodenal ulcer - with the gallbladder. Both complication perforation recognized easily as filling the colon is set in a typical picture of Australia; not less easy to define a message filled with contrasting lot of gall bladder in his closed pear-shaped form.
Further, as complications perforative ulcers occur subphrenic abscess and pneumothorax at the break of abscess through the diaphragm. Encysted abscesses can be recognized only when, in the cavity of their contained gas. The gas bubble is located in such cases above the horizontal level of the liquid.
One of the types of complications perforative ulcer is the so-called closed with a perforation. In such cases there is a deep barium depot, resembling a large ulcer niche of irregular shape, connected by a narrow passage with the wall of the stomach or duodenum without any signs of pneumoperitoneum. If it takes several hours after the occurrence of perforation, then this may result in signs of peritonitis, reflected in significant swelling of intestines with the appearance of a horizontal fluid levels. Unlike paintings mechanical obstruction missing reinforced peristalsis of intestines, what are the features of paralytic form of obstruction, appearing as a late sign accompanying perforating ulcer.