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A perforated ulcer can be grouped into a stercoral perforation which involves a number of different things that cause perforation of the intestine wall. The first symptom of a perforated peptic ulcer is usually sudden, severe, sharp pain in the abdomen. [1] The pain is typically at its maximum immediately and persists.
It often results in a small bowel obstruction. [1] Other complications may include peritonitis or bowel perforation. [1] The cause in children is typically unknown; in adults a lead point is sometimes present. [1] Risk factors in children include certain infections, diseases like cystic fibrosis, and intestinal polyps. [1]
In intestinal perforation, gas may be visible under the diaphragm on chest x-ray while the patient is in an upright position. While x-ray is a fast and inexpensive to screen for perforation, an abdominal CT scan with contrast is more sensitive and specific for establishing a diagnosis as well as determining the underlying cause. [19]
Volvulus causes severe pain and progressive injury to the intestinal wall, with accumulation of gas and fluid in the portion of the bowel obstructed. [11] Ultimately, this can result in necrosis of the affected intestinal wall, acidosis, and death. This is known as a closed-loop obstruction because there exists an isolated ("closed") loop of bowel.
Elevations in fecal calprotectin correlate with the extent of intestinal inflammation. [2] Computed tomography (CT) imaging may show evidence of colitis, though the sensitivity is relatively low (50%). [1] Free air in the peritoneum indicates bowel perforation. [1] Abdominal imaging may be necessary to rule out toxic megacolon or perforation. [1]
Perforation of the colon [3] Sepsis; Shock; Emergency action may be required if severe abdominal pain develops, particularly if it is accompanied by fever, rapid heart rate, tenderness when the abdomen is pressed, bloody diarrhea, frequent diarrhea, or painful bowel movements.
Perforation and hemorrhage, the main complications, cause a mortality rate higher than 50% due to related diseases in the population at risk. If a patient has a history of constipation and presents with acute abdominal pain and clinical findings consistent with a hollow viscus perforation, the diagnosis of perforated stercoral ulceration should ...
Causes include perforation of the intestinal tract, pancreatitis, pelvic inflammatory disease, stomach ulcer, cirrhosis, a ruptured appendix or even a perforated gallbladder. [3] Risk factors include ascites (the abnormal build-up of fluid in the abdomen) and peritoneal dialysis. [4]