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Penetration of gastric and duodenal ulcers
Last reviewed: 23.04.2024
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Penetration of an ulcer is the penetration of an ulcer into adjacent organs and tissues. Ulcers of the posterior wall of the bulb of the duodenum and postbulbarnye ulcers penetrate mainly into the head of the pancreas; less often - in the major bile ducts, liver, hepatic-gastric ligament, very rarely - into the large intestine and her mesentery.
Mediogastric ulcers penetrate most often into the body of the pancreas and a small omentum.
[Symptoms of ulcer penetration
Penetrating ulcer is characterized by the following manifestations:
- pains in the epigastric region become intense and permanent, they lose the characteristic earlier rhythm of the day and the connection with food intake;
- there is a characteristic irradiation of pain, depending on which organ the ulcer penetrates. When penetrating into the pancreas, the pain radiates mainly to the right, less often to the left lumbar region; quite often there is an irradiation in the back or the pain acquires a shingling character;
- at penetration of a stomach ulcer in a small omentum of pain irradiate up and to the right (sometimes in the right shoulder, collarbone); with the penetration of highly located ulcers, the irradiation of pain to the heart region is possible; when the postbulburn ulcer penetrates into the mesentery of the colon, the pain irradiates downward and towards the navel;
- in the projection of penetration, pronounced local soreness is determined and quite often - an inflammatory infiltrate;
- there are symptoms of damage to those organs in which the ulcer penetrates;
- body temperature rises to subfebrile.
Laboratory and instrumental data
- OAK: neutrophilic leukocytosis and an increase in ESR are noted.
- FGDs: for penetrating ulcers, characteristic round or polygonal edges that rise in the form of a shaft around the ulcer. The crater of the ulcer is deep.
- X-ray of the stomach: the depth of the ulcer increases significantly, the mobility of the zone in which the ulcer is located is limited.
- Laparoscopy: you can directly see the soldering of the organ into which the ulcer penetrates, respectively, to the stomach or the duodenum.
- Ultrasound of the abdominal cavity: you can see a changed acoustic picture of the liver or pancreas when the ulcer penetrates into these organs.