The most common cause of gastric perforation is peptic ulcer, which usually presents with sudden onset of severe abdominal pain that begins in the upper abdomen and quickly spreads throughout the abdomen, without intermittent bouts of pain.
Gastric ulcers and stress ulcers are the most common causes of gastric perforation. Gastric cancer and trauma can also cause gastric perforation, and common triggers are alcohol abuse, smoking, overeating, and long-term use of hormones and nonsteroidal anti-inflammatory drugs.
A large amount of gastric juice flowing into the peritoneal cavity after gastric perforation causes chemical peritonitis, followed by bacterial peritonitis, which can lead to toxic shock and endanger life if not rescued in time.
Patients usually present with sudden onset of severe abdominal pain, starting in the subxiphoid or epigastric region, with a knife-like or burning pain, often persistent and worsening in paroxysms, which spreads rapidly throughout the abdomen and may radiate to the back of the posterior shoulder.
Some patients will have nausea and vomiting, mostly mild, and when bowel paralysis occurs it is accompanied by abdominal distention, and the vomiting may worsen.
If untreated, the disease progresses and diffuse peritonitis develops, and the patient may present with toxic shock such as decreased blood pressure and unconsciousness.
Patients may also present with fever, rapid heart rate, and shortness of breath.
On examination, there are signs of platysmal abdomen, that is, full abdominal pressure, rebound pain, plate-like abdominal muscle tension, and narrowing or disappearance of the hepatic turbinate zone.
Treatment is usually surgical. Small perforations without peritonitis can be treated conservatively with indwelling gastric tube, aspiration of gastric juice, anti-infection, and rehydration to correct water-electrolyte disturbances.