Acute perforation is a common and serious complication of gastroduodenal ulcer nowadays the incidence of ulcer perforation is on the rise the age of onset is getting older but duodenal ulcer perforation is mostly seen in male patients with anterior wall of the bulb gastric perforation is mostly seen in older women with gastric cervix a few patients have ulcer perforation again. The pathogenesis of acute perforation of gastroduodenal ulcer: The course of gastroduodenal ulcer is a dynamic process that is the result of the interaction between the defense mechanisms of the gastroduodenal mucosa and the injury factors The recurrence and remission of ulcer disease reflects the alternation of ulcer development and healing processes This long-term transplantation process repeatedly destroys the tissue imaging structure of the gastroduodenal wall and is replaced by fibrous scarring granulation tissue and necrotic focus tissue is replaced by eventually penetrate the muscular plasma layer to form acute perforation (anterior wall) or talent chronic penetrating ulcer (posterior wall) acute perforation after gastroduodenal fluid and food into the applied peritoneal cavity causing chemical peritonitis a few hours later due to bacterial multiplication is transformed into bacterial peritonitis bacterial toxins are absorbed after the diagnosis patient can develop toxic shock on the basis of the original hypovolemic excellent now also applied found acute gastric Perforated duodenal ulcer is also closely related to H. pylori. The founder of acute perforation of gastroduodenal ulcer clinical manifestations: previous history of ulcer disease also a few people without previous history of ulcer disease several days before perforation ulcer disease symptoms aggravated or mood swings excessive fatigue and other triggers in the night after fasting or full stomach suddenly occur acute pain under the saber abdomen severe pain is torn or knife-like pain patients unbearable accompanied by pale face cold sweat pulse fine speed and other manifestations often accompanied by nausea and vomiting pain The pain quickly spreads to the whole abdomen and sometimes… Gastric contents may flow down along the right paracolic sulcus and right lower abdominal pain may be slightly reduced later due to dilution of large amounts of medical abdominal exudate abdominal pain may be slightly reduced later due to secondary bacterial infection abdominal pain may be aggravated again patient’s expression is now painful; supine position and reluctance to change position abdominal breathing is weakened or disappeared abdominal muscle tension is “plank-like” tonic pain throughout the abdomen rebound pain right upper abdominal pressure pain obvious percussion with mobile turbid sounds hepatic turbid borders narrowed or disappeared bowel sounds significantly weakened or disappeared standing position x-ray examination % of patients with AC see free gas shadow under the right diaphragm. The diagnosis of acute perforation of gastroduodenal ulcer in internal medicine: based on the history of previous ulcers sudden onset of persistent severe epigastric pain and quickly turning into total abdominal pain physical examination with signs of peritoneal irritation hepatic turbinates narrowed intestinal sounds diminished or disappeared X-ray examination can be diagnosed by seeing the presence of subdiaphragmatic free gas focus if in doubt feasible cooperative abdominal puncture. The following conditions often lead to diagnostic difficulties in Hangzhou: (1) no previous history of typical ulcers; (2) elderly or pediatric patients with poorly described symptoms. Signs are atypical; (3) fasting onset and small perforations with little leakage: (4) small perforations with posterior wall ulcers leaking into the small omental sac; (5) very weak; (6) obese individuals; (7) use of analgesics after the onset of the disease; (8) no subdiaphragmatic free gas on X-ray; signs and symptoms may be atypical in the above cases. The diagnostic team needs to be differentiated from the following inpatient diseases: 1. Acute pancreatitis is also a sudden onset of severe pain in the upper abdomen accompanied by vomiting and signs of peritoneal irritation Acute pancreatitis is mostly left upper abdominal pain radiating to the lower back but no subdiaphragmatic free gas on X-ray Serum amylase exceeds Soxhlet units . 2, acute cholecystitis for the right upper abdomen severe colic or continuous pain paroxysmal intensification of radiation to the right shoulder with chills and fever positive signs included mainly in the right upper abdomen manifested by the establishment of local pressure pain and rebound pain sometimes can be palpable enlarged gallbladder Murphy’s sign positive ultrasound suggests cholecystitis and (or) gallbladder stones 3, acute appendicitis ulcer perforation of the leakage flow to the right lower abdomen occurs right lower abdominal pain and pressure pain rebound pain can be confused with acute appendicitis However, the general symptoms of acute appendicitis are not as severe as ulcer perforation and there is no pneumoperitoneum differential diagnosis in the United States relying on the main signs of the respective antibodies is still limited to the focal area X-ray examination helps to differentiate. Acute perforation of gastroduodenal ulcer treatment found: 1, non-surgical application of treatment incumbent adapted to the general condition of good young results of the main organs without lesions ulcers shorter history of symptoms and signs light fasting perforated patients culture can be used as appropriate gastrointestinal decompression auxiliary fluids and antibiotics now for treatment by non-surgical primary treatment of youth – hours after the aggravation of the disease should be immediately changed to surgery adhere to treatment Naturally for non-surgical bachelor after treatment healed patients Hangzhou need to perform gastroscopy to rule out gastric cancer for H. pylori positive people should be added to remove the bacteria and acidulant treatment knowledge. 2.Surgical inpatient Liaoning treatment has two types of surgical methods: simple perforation suturing and complete ulcer founder surgery The advantage of simple perforation suturing is that it is easy to operate and easy to perform the surgery prominently in a short time with less danger, but its disadvantage is that there are / master patients who later perform a second complete gynecological surgery because the ulcer has not healed, while the advantage of complete ulcer American surgery is that one surgery section gynecological at the same time solves the perforation and ulcer Two doctoral problems can be eliminated later re-operation main treatment but the operation is more complex and dangerous should be selected according to the patient’s general condition many times learn intra-abdominal inflammatory and ulcerative lesions are generally considered: if the work patient is in good general condition has a history of pyloric obstruction or bleeding perforation time within hours abdominal inflammation and edema of the gastroduodenal wall is found to be less. Young and complete surgical article can be performed. Otherwise, the perforation can be sutured for a complete surgical procedure including: gastrectomy for duodenal ulcer perforation to perform said nerve cut plus sinus resection or suturing the perforation after performing a nerve cut plus gastrojejunostomy or highly selective vagotomy, etc. In recent years, due to the increasing age of young patients with duodenal ulcer perforation, the risk of surgical cooperation increases naturally, therefore, the question arises whether to perform ulcer perforation suturing of the abdominal cavity while performing thorough treatment of ulcer perforation to guide the Society for Surgery engaged in the citation of ulcer perforation in patients with serious diseases of the major intervening organs Associate Professor of preoperative shock perforation time of more than hours is three risk factors for patients with abundant perforation if there are no such three factors. The mortality rate of young surgical patients without these three factors is . In patients with two or more factors, only multiple procedures are performed to repair the perforated ulcer with sutures. Patients who have undergone one of the ulcer perforation suture treatments should be given acid suppressants plus H. pylori eradication research until gastroscopic confirmation of ulcer healing and eradication of H. pylori.