Stomach perforation can be life-threatening if not recognized on time, and various causes have been described in the literature [1]. Peptic ulcer disease (PUD) and perforation, long-term administration of non-steroidal anti-inflammatory drugs (NSAIDs), malignancies involving the gastrointestinal system (GI), medical procedures (eg. intubation, GI surgery), and ingestion of foreign bodies (toothpicks, metal coins, etc.), either incidental or intentional, are notable etiologies of stomach perforation [1] [2] [3] [4] [5] [6] [7]. In addition, incarcerated hiatal hernia is also reported as a condition that may lead to perforation [8]. The clinical presentation is often nonspecific, with most common symptoms being abdominal distension and pain accompanied by an abnormal sensation in the epigastric area and reduced appetite [3]. Signs of peritonitis might be seen as well [9]. Perforation caused by foreign bodies tend to have a chronic course, and days or weeks often pass before the diagnosis is made [3] [9]. On the other hand, severe forms have an abrupt onset, in which case a prompt diagnosis is imperative. Unfortunately, some patients may have an asymptomatic presentation, thus the diagnosis might be delayed for a significant period of time [9].

• Fever

  Speak to a doctor if you experience any significant change from your normal state, especially if you have abdominal pain and fever. [healthline.com]

  After a period of seven days the patient was readmitted to the PICU, with signs and symptoms of acute abdomen: severe epigastric pain whose intensity increased with the change of position, nausea, vomiting, fever and chills. [cejpaediatrics.com]

  A perforation may also occur in the gallbladder, and symptoms include severe stomach pain, vomiting, and fever. [sheknows.com]

  A 41-year-old man presented weight loss, low grade fever, and vomiting. Upper gastrointestinal endoscopy showed a large ulcer on the antrum of the stomach. [jstage.jst.go.jp]

  You have a fever. You have frequent episodes of nausea and vomiting. Care Agreement You have the right to help plan your care. Learn about your health condition and how it may be treated. [drugs.com]

• Sepsis

  Sepsis If left untreated (hours or days), perforation can lead to Sepsis. Sepsis is a life-threatening complication of the infection process. [cuthbertlaw.com]

  […] entire body If either peritonitis or sepsis is suspected, then immediate medical attention must be sought. [dovemed.com]

  Body-wide infection is called sepsis. Sepsis can be very serious and can lead to death. [medlineplus.gov]

  Factors that increase the risk of this include: malnutrition, or poor diet smoking excessive alcohol use drug abuse poor hygiene sepsis uremia, which is an illness caused by kidney failure obesity hematoma, which occurs when blood collects outside the [healthline.com]

• Inflammation

  When a hole occurs in the gut, its contents escapes into the peritoneal cavity causing inflammation of the peritoneum – peritonitis. This inflammation can quickly spread to surrounding organs, irritating and damaging it to varying degrees. [healthhype.com]

  The spilling of contents into the peritoneal cavity causes inflammation of the membrane that lines the abdominal cavity, known as peritonitis, due to digestive enzymes, stomach acid, and gut bacteria invading a space they shouldn’t be. [belmarrahealth.com]

  The body’s fight against the infection, triggers inflammation throughout the body doing damage to multiple organ systems, causing them to fail. [cuthbertlaw.com]

  Histopathology of the margins revealed acute nonspecific inflammation. Cause of death was prematurity with septicaemia. [afrjpaedsurg.org]

  If the obstruction is caused by inflammation, proton pump inhibitors (PPIs) or H2-receptor antagonists can be used to reduce stomach acid levels until the swelling goes down. [nhs.uk]

• Weight Loss

  April 15, 2016 Weight loss procedures help patients get a significant amount of weight off. Patients have improvements in mobility and co-morbid conditions such as sleep apnea, diabetes, high blood pressure, cholesterol and joint pain. [obesityhelp.com]

  She underwent a 2-hour, elective, LAP-band insertion operation to achieve weight loss; 27 hours after band insertion, following the conduction of all FDA-mandated Lap-Band postoperative protocol (including a radiologic Gastrogrografin swallow), the patient [ncbi.nlm.nih.gov]

  A 41-year-old man presented weight loss, low grade fever, and vomiting. Upper gastrointestinal endoscopy showed a large ulcer on the antrum of the stomach. [jstage.jst.go.jp]

  You should see a doctor if you have any of the following: Blood when you have a bowel movement Severe abdominal pain Heartburn not relieved by antacids Unintended weight loss Ongoing vomiting or diarrhea NIH: National Institute of Diabetes and Digestive [icdlist.com]

• Severe Pain

  Acute stomach pain must be taken seriously and treated seriously. Too often complaints of severe abdominal pain are written off by doctors as constipation or some other less critical condition. [cuthbertlaw.com]

  Symptoms develop suddenly, with severe pain followed shortly by signs of shock. Diagnosis is usually made by the presence of free air in the abdomen on imaging studies. Treatment is with fluid resuscitation, antibiotics, and surgery. [merckmanuals.com]

  Severe abdominal pain and tenderness Swelling of the abdomen Fever Nausea or vomiting How is a perforated bowel diagnosed? A CT scan of your abdomen will be used to show any perforation in your bowel. [drugs.com]

  Call 999 or go to A&E if you: have sudden, severe stomach pain have pain when you touch your stomach are vomiting blood or a ground coffee like substance have bloody or black, sticky poo These could be signs of something more serious. [beta.nhs.uk]

• Vomiting

  Symptoms can include: repeated episodes of vomiting, with large amounts of vomit that contain undigested food a persistent feeling of bloating or fullness feeling very full after eating less food than usual unexplained weight loss An endoscopy can be [nhs.uk]

  Symptoms may include: Severe abdominal pain Chills Fever Nausea Vomiting Shock X-rays of the chest or abdomen may show air in the abdominal cavity. This is called free air. It is a sign of a tear. [medlineplus.gov]

  After a period of seven days the patient was readmitted to the PICU, with signs and symptoms of acute abdomen: severe epigastric pain whose intensity increased with the change of position, nausea, vomiting, fever and chills. [cejpaediatrics.com]

  A perforation may also occur in the gallbladder, and symptoms include severe stomach pain, vomiting, and fever. [sheknows.com]

  A 41-year-old man presented weight loss, low grade fever, and vomiting. Upper gastrointestinal endoscopy showed a large ulcer on the antrum of the stomach. [jstage.jst.go.jp]

• Abdominal Pain

  Three weeks later he had abdominal pain, and upper gastrointestinal endoscopy showed a huge perforation of the ulcer on the antrum of the stomach. The abdominal CT showed a large quantity of free air and ascites. [jstage.jst.go.jp]

  Abdominal pain and an epigastric sensation are notable symptoms, while some individuals have a completely asymptomatic course. [symptoma.com]

  […] intestine), any congenital abnormality of the intestine, surgery involving the abdominal organs, and cancer The signs and symptoms of perforation may include fever and chills, nausea, vomiting, severe abdominal pain and abdominal hardness, bloody stools [dovemed.com]

  Symptoms may include: Severe abdominal pain Chills Fever Nausea Vomiting Shock X-rays of the chest or abdomen may show air in the abdominal cavity. This is called free air. It is a sign of a tear. [medlineplus.gov]

  pain and exhibit signs of peritonism at presentation. [pdfs.semanticscholar.org]

• Nausea

  After a period of seven days the patient was readmitted to the PICU, with signs and symptoms of acute abdomen: severe epigastric pain whose intensity increased with the change of position, nausea, vomiting, fever and chills. [cejpaediatrics.com]

  You have frequent episodes of nausea and vomiting. Care Agreement You have the right to help plan your care. Learn about your health condition and how it may be treated. [drugs.com]

  Symptoms may include: Severe abdominal pain Chills Fever Nausea Vomiting Shock X-rays of the chest or abdomen may show air in the abdominal cavity. This is called free air. It is a sign of a tear. [medlineplus.gov]

  For several days after the surgery, the patient was unable to move his bowels and had significant abdominal pain, bloating, nausea, and lethargy. [theexpertinstitute.com]

• Severe Abdominal Pain

  […] intestine), any congenital abnormality of the intestine, surgery involving the abdominal organs, and cancer The signs and symptoms of perforation may include fever and chills, nausea, vomiting, severe abdominal pain and abdominal hardness, bloody stools [dovemed.com]

  This causes a severe infection called peritonitis. Symptoms may include: Severe abdominal pain Chills Fever Nausea Vomiting Shock X-rays of the chest or abdomen may show air in the abdominal cavity. This is called free air. It is a sign of a tear. [medlineplus.gov]

  abdominal pain and exhibit signs of peritonism at presentation. [pdfs.semanticscholar.org]

  You should see a doctor if you have any of the following: Blood when you have a bowel movement Severe abdominal pain Heartburn not relieved by antacids Unintended weight loss Ongoing vomiting or diarrhea NIH: National Institute of Diabetes and Digestive [icdlist.com]

  A 63-years-old woman was admitted to our hospital complaining of severe abdominal pain. On physical examination, tenderness and rebound tenderness were noted in the upper abdomen. [ginmu.naramed-u.ac.jp]

• Acute Abdomen

  After a period of seven days the patient was readmitted to the PICU, with signs and symptoms of acute abdomen: severe epigastric pain whose intensity increased with the change of position, nausea, vomiting, fever and chills. [cejpaediatrics.com]

  Diagnosis of an acute abdomen can often be made on clinical grounds and an emergency operation performed. Posterior perforation of gastric ulcer is a unique category of peptic ulcer perforations with a distinct clinical presentation (1). [pdfs.semanticscholar.org]

  Investigations Laboratory Tests Any patient with an acute abdomen will require routine baseline blood tests, including G&S. [teachmesurgery.com]

  Some Causes of GI Tract Perforation Symptoms and Signs Esophageal, gastric, and duodenal perforation tends to manifest suddenly and catastrophically, with abrupt onset of acute abdomen with severe generalized abdominal pain, tenderness, and peritoneal [merckmanuals.com]

  Acute abdomen. In: Townsend CM Jr, Beauchamp RD, Evers BM, Mattox KL, eds. Sabiston Textbook of Surgery. 20th ed. Philadelphia, PA: Elsevier Saunders; 2017:chap 45. Wagner JP, Chen DC, Barie PS, Hiatt JR. Peritonitis and intraabdominal infection. [medlineplus.gov]

• Chest Pain

  The symptoms of esophageal rupture may include sudden onset of chest pain. [en.wikipedia.org]

  Thoracic Any thoracic region perforation will present with pain, ranging from chest pain or neck pain to pain radiating to the back or pain on inspiration. [teachmesurgery.com]

• Seizure

  Case presentation A 47-year-old man was hospitalized in our intensive care unit (ICU) for generalized seizures and hypotension. Three days before admission, he suffered from fatigue, fever, vomiting, abdominal pain and lower GI hemorrhage. [bmcinfectdis.biomedcentral.com]

Because of the nonspecific presentation of gastric perforation, many studies have stressed the importance of a proper physical examination and a detailed patient history [3] [7]. Patients should be asked about the duration of symptoms and the nature of their onset, whereas assessment of risk factors (underlying malignant disease or peptic ulcer, use of NSAIDs, recent upper gastrointestinal tract instrumentation or ingestion of foreign bodies) is also vital during clinical assessment. Once a presumptive diagnosis of an upper GI pathology is made, imaging studies are the next step of the diagnostic workup. Barium studies are not recommended in the setting of gastrointestinal perforation, but plain radiography of the chest and abdomen (lateral images are superior to posteroanterior) can be a useful initial method that is able to detect free air under the diaphragm in up to 75% of cases [6] [10]. However, contrast-enhanced CT, considered as the gold standard [10], is employed in the presence of inconclusive findings on abdominal X-rays. Typical signs are defects in the stomach wall and the presence of gas in the supramesocolic compartment (the space over the transverse mesocolon in the peritoneum) [10]. Abdominal ultrasonography has also been described as a useful tool in the evaluation of gastric perforation [6]. Finally, a biopsy of the lesion at the site of perforation, especially if suspicion toward a malignancy exists, might be performed [11], primarily through endoscopic techniques.

• Leukocytosis

  A complete blood count (CBC) may reveal parameters suggestive of infection (eg, leukocytosis), though leukocytosis may be absent in elderly patients. Elevated packed blood cell volume suggests a shift of intravascular fluid. [slideshare.net]

Patients usually present with atypical symptoms, and the treatment of such pyogenic liver abscesses presents a challenge. Here we report a case of hepatic abscess secondary to stomach perforation by a fish bone. [ncbi.nlm.nih.gov]

Despite the best available treatments, leaks can be hard to treat and frequently multiple modalities are necessary. [obesityhelp.com]

And, delaying treatment can increase the risk of serious complications and even death. [stomachbloating.net]

The chances of recovery improve with early diagnosis and treatment. [healthline.com]

You may need emergency treatment or surgery. [beta.nhs.uk]

The prognosis of DLBCL patients with GI involvement was retrospectively investigated regarding treatments. [bloodjournal.org]

CONCLUSION: Gastric cancer perforation is rare and of bad prognosis as it survives on advanced cancer. [ncbi.nlm.nih.gov]

DISCUSSION Neonatal gastric perforation is extremely rare and associated with poor prognosis [1] [2] [4]. Various theories have been proposed describing the etiology and prognosis but it still remains obscure [1] [2] [3] [5]. [ijcasereportsandimages.com]

Prognosis A GI perforation is a medical emergency and requires quick recognition of the signs and symptoms, and rapid medical response. When this occurs, recovery should be complete. [sepsis.org]

[…] anti-inflammatory drugs (NSAIDs), malignancies involving the gastrointestinal system (GI), medical procedures (eg. intubation, GI surgery), and ingestion of foreign bodies (toothpicks, metal coins, etc.), either incidental or intentional, are notable etiologies [symptoma.com]

ABSTRACT Introduction : Gastric perforation in neonates is a rare surgical emergency of uncertain etiology. [ijcasereportsandimages.com]

Etiologies include gastrogastric fistula, excessively large gastric pouch containing antral mucosa, H pylori infection, non-steroidal anti-inflammatory drugs use, and smoking [1, 2]. [websurg.com]

Kneiszi F: Some data on the etiology of gastric rupture in the newborn, Biol Neonate; 1962; 4: 201-222. 11. Lloyd JR: The etiology of gastrointestinal perforations in the newborn. J Pediatr Surg; 1969; 4: 77-84. 12. [ispub.com]

An Atlas of Operative Laparoscopy and Hysteroscopy, Second Edition is not just a how-to-do-the-surgery book, but also a guide to the pathogenesis, pathophysiology, and epidemiology of the urogynecological area. [books.google.com]

Time-trends in the epidemiology of peptic ulcer bleeding. Scand J Gastroenterol. 2005; 40 :914–20. 3. Sharma SS, Mamtani MR, Sharma MS, Kulkarni H. [tropicalgastro.com]

Systematic review of the epidemiology of complicated peptic ulcer disease: incidence, recurrence, risk factors and mortality. Digestion 2011; 84:102-113. 4. Williams N, Bullstrode C, Connell RO. [ejs.eg.net]

The Zidovudine Epidemiology Study Group. J Infect Dis. 1992, 166: 1223-1227. [bmcinfectdis.biomedcentral.com]

An Atlas of Operative Laparoscopy and Hysteroscopy, Second Edition is not just a how-to-do-the-surgery book, but also a guide to the pathogenesis, pathophysiology, and epidemiology of the urogynecological area. [books.google.com]

The possible reasons for the high mortality and morbidity rates at that time may have been related to the following factors: Knowledge in the area of bowel injuries and the pathophysiologic changes triggered by such injuries was inadequate Clinical skills [emedicine.medscape.com]

Neonatalogy: Pathophysiology and Management of the Newborn. Philadelphia, PA: Lippincott Williams and Wilkins; 1999. p. 1022–1023. 3 Chung MT, Kuo CY, Wang JW, Hsieh WS, Huang CB, Lin JN. [nature.com]

Prevent Risks of a Leak/Perforation In the first few weeks after surgery, don’t gulp, don’t overeat, and follow the rules your surgical team has set out for you. Prevention of a leak may, at best, be minimizing risky or unpredictable behaviors. [obesityhelp.com]

Onset of symptoms that are characteristic of a perforated gastric ulcer should therefore be addressed immediately to prevent the situation from becoming increasingly dangerous. [stomachbloating.net]

Preventing stomach ulcers To help prevent stomach ulcers or stop them coming back: Do regularly wash your hands with soap and water - to reduce the chance of bacterial infections only take ibuprofen, aspirin and other NSAIDs when you need them follow [beta.nhs.uk]

Contained perforation occurs when a full-thickness hole is created by an ulcer, but free spillage is prevented because contiguous organs wall off the area (as occurs, for example, when a duodenal ulcer penetrates into the pancreas). [slideshare.net]

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9. Mehran A, Podkameni D, Rosenthal R, Szomstein S. Gastric Perforation Secondary to Ingestion of a Sharp Foreign Body. JSLS. 2005;9(1):91-93.
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