(b) Perforation. Erosion of an ulcer through the wall of an organ (for
example, the stomach) is called perforation. The patient experiences sudden, severe
pain which is located in the middle portion of the stomach. If these symptoms are
severe enough, the patient may faint but regain consciousness quickly when placed in
the recumbent position (lying down). The pain may radiate to the shoulders and the
right lower quadrant of the abdomen then lessen for a few hours. When palpated, the
abdomen is found to be tender, abdominal muscles are rigid, and bowel sounds are
quieter than normal. The patient usually lies as still as possible in an effort to avoid any
movement which will increase the pain. Sometimes even breathing makes the pain
worse. If surgery is delayed more than 24 hours, begin gastric suction, antibiotics, and
(c) Penetration. This complication is the extension of the ulcer crater
beyond the duodenal wall into the adjacent organs. The penetration actually extends
into the deep tissues of an organ; for example, a duodenal ulcer may penetrate into the
pancreas or liver. Symptoms include intense pain which is persistent and which may
occur in the back. Location of the pain may change with the way the patient sits or lies
down. The pain is more intense at night, and the patient gets no relief from eating food
or taking antacids. A patient with a long history of duodenal ulcer who suddenly
experiences these symptoms will usually have an ulcer complicated by penetration.
When treatment by antacids is unsuccessful in producing healing, surgery is necessary.
(d) Obstruction. Obstruction as an ulcer complication refers to the
blocking or clogging of the gastrointestinal tract. There are two types of pyloric
obstruction due to ulcer: spastic obstruction and scar obstruction. Spastic obstruction
is characterized by edema (swelling) underlying spasm of the pylorus (the opening
between the stomach and duodenum through which stomach contents pass in the
digestive process) and the duodenum (the first part of the small intestine). An active
ulcer causes spastic obstruction. With proper treatment, patients with spastic
obstruction can recover completely, or they may have repeated attacks fully recovering
from each attack. Scar pyloric obstruction is caused by the healing process of an ulcer.
Scar tissue has formed at the opening of the pylorus and duodenum causing that
opening to become narrower. This condition can only be corrected surgically.
Symptoms include vomiting and bloating or fullness after eating. Because of these
feelings, the patient may have limited his own food intake and lose weight as a result.