Gastric Perforation

Excerpt

Perforation of the stomach is a full-thickness injury of the wall of the organ. Since the peritoneum completely covers the stomach, perforation of the wall creates a communication between the gastric lumen and the peritoneal cavity. If the perforation occurs acutely, there is no time for an inflammatory reaction to wall off the perforation, and the gastric contents freely enter the general peritoneal cavity, causing chemical peritonitis. Perforations occurring over a prolonged period may be contained locally by the inflammatory reaction. Perforation may be suspected based upon the patient’s clinical presentation, or the diagnosis become obvious through a report of extraluminal ”free air” on diagnostic imaging performed to evaluate for abdominal pain or another symptom. Treatment is a surgical repair. During surgery, most of the perforations are linear and found high in the stomach and along the greater curvature. The perforation is usually closed with a patch made of omentum or the perforated area may undergo a wedge resection.