I suddenly had severe pain in my abdomen. Could it be gastric perforation? Let's see how the experts diagnosed it.

In daily life, stomachache is common. However, some people who are suspicious always think the worst. For example, they will think: Is it a perforated stomach?

In fact, there are many reasons for stomach pain, not all of which are caused by gastric perforation. For example, cholecystitis, appendicitis or pancreatitis can cause similar stomach pain.

Speaking of how to distinguish them, let’s first look at a case we had a few days ago. This is a typical case of gastric perforation.

That day, the emergency department notified us that they needed to prepare an operating room immediately and that the patient would be in soon. We were thinking: What kind of patient is this? Why is he so urgent? Besides, we didn't hear about any major rescue efforts, and there shouldn't be any heavy bleeding or anything like that.

With doubts in mind, we quickly prepared an operating room.

Just as we were getting ready, the emergency department asked to take the patient. Oh, no. To be exact, it was the general surgery department that asked to take the patient.

What made us even more surprised was that the phone used was the landline of the Radiology Department.

After the surgeon came in, the question was answered: It turned out that when the patient with abdominal pain was sent to the CT room, the surgeon followed him. When he found free gas in the abdominal cavity, he decided to perform surgery without hesitation. This is because one of the typical characteristics of digestive tract perforation is free gas in the abdominal cavity.

Although the patient was still conscious, her pale lips and cold hands and feet indicated that she was in shock, so we started to treat the shock while administering anesthesia.

After the anesthesia was completed, the surgeon immediately started the operation. After opening the abdominal cavity, a sour smell hit me in the face.

After seeing this situation, we couldn't hide anymore. This meant that the patient had definitely had a perforation of the digestive tract. Based on experience, it should be an upper digestive tract perforation. So the surgeon flushed the abdominal cavity while searching for the hole.

Finally, a hole in the stomach was found behind a red greater omentum that had been eroded by gastric acid.

Without hesitation, the surgeon decided to perform a partial gastrectomy on her.

After the operation, we couldn't help but feel worried for the patient: Fortunately, she didn't just take medicine at home and treat it as a stomach problem. This perforation is almost a gradual development. Once it reaches a serious shock level, it may even lose the opportunity for surgery.

Some people say, why can’t shock be treated by cutting?

Actually, from a purely surgical point of view, there is no surgery that cannot be performed. However, we must consider the consequences of the surgery, right? If the surgery is successful but the patient dies, what is the point of the surgery?

In order to ensure the safety of surgery, the Department of Anesthesiology will do its utmost to ensure the safety of patients. However, for critical illnesses, doctors need not only technology, but also a firm stance from the patient's family. When family members hesitate, doctors must hesitate. After hesitation, doctors will take a relatively conservative approach. Take our Department of Anesthesiology as an example. In a rescue operation with only a small probability of success, if the family members are determined, they will have a chance to win that little bit of chance. If the family members are there wondering who is responsible, then no one would dare to rush forward. In clinical practice, many family members are not thinking, but just hesitating. And this hesitation may lead to missed opportunities.

Therefore, we recommend that: since you have come to the hospital, you should first trust the doctor.

Back to the beginning, how do we find out if it is a serious problem like gastric perforation?

As a doctor, the diagnosis of gastric perforation includes:

1. Symptoms, combined with typical symptoms of gastric perforation, such as abdominal pain, nausea and vomiting;

2. Relevant medical history, such as gastric and duodenal ulcers, gastrointestinal tumors, and history of overeating;

3. Physical examination: after the onset of the disease, abdominal wall tenderness and rebound pain may be found. The area of ​​liver dullness disappears or is significantly reduced;

4. Routine blood test: Routine blood test shows a significant increase in white blood cells and neutrophils;

5. Imaging examination: Abdominal X-ray examination shows typical "free gas under the diaphragm". The above information can provide a basis for the effective diagnosis of gastric perforation.

As a patient, typical symptoms of gastric perforation include:

1. Abdominal pain. Patients may suddenly experience severe abdominal pain. The initial pain site is the gastric perforation site or the upper abdomen, and the pain is persistent. The pain is burning or knife-like. Some patients may experience paroxysmal abdominal pain, and the pain may spread from the initial site to multiple locations throughout the body.

2. Nausea and vomiting. Many patients with gastric perforation will also experience nausea and vomiting after the onset of the disease. Nausea and vomiting are also accompanied by constipation and abdominal distension.

3. Shock. Gastric perforation may cause bacterial peritonitis. If it cannot be corrected quickly, it may manifest as toxic shock and requires rapid treatment.

4. Other symptoms. Some patients with gastric perforation may also experience other symptoms after the onset of the disease, such as accelerated pulse, fever, and decreased blood pressure.

All diseases require early diagnosis and early treatment. Share valuable information, eliminate knowledge barriers, and improve health concepts~