A stomach rupture, medically termed gastric perforation, is a severe, life-threatening medical emergency. This condition occurs when a full-thickness hole develops in the stomach wall. The breach allows acidic contents, digestive enzymes, and bacteria to leak into the sterile abdominal cavity (peritoneum). This contamination triggers peritonitis, a widespread inflammatory response that can rapidly progress to sepsis. Immediate surgical intervention is required to close the defect and clean the cavity, as delays can lead to multi-organ failure and death.
Identifying the Causes of Gastric Perforation
The most frequent cause of gastric perforation is untreated or complicated peptic ulcer disease (PUD). These ulcers, often caused by chronic Helicobacter pylori infection or prolonged use of non-steroidal anti-inflammatory drugs (NSAIDs), gradually erode the stomach lining. As the ulcer deepens, it bores completely through the muscular wall, creating an opening into the abdomen.
Traumatic injuries, resulting from external or internal physical forces, are another cause. Blunt force trauma, such as from a severe car accident, causes rupture due to sudden, intense pressure. Penetrating trauma, including stab or gunshot wounds, directly punctures the stomach wall, resulting in immediate leakage.
Iatrogenic injury is a complication arising from a medical procedure. Endoscopic procedures, such as upper gastrointestinal endoscopies or biopsies, carry a small risk of inadvertently creating a tear.
Less commonly, ingestion of certain materials can lead to rupture. Swallowing sharp foreign objects, such as bones or metal fragments, can physically perforate the wall. Ingestion of caustic substances, like strong acids or alkalis, causes chemical burns that destroy tissue, leading to necrosis and perforation.
Malignancy, specifically advanced gastric cancer, can also lead to perforation. As a cancerous tumor grows and destroys tissue, it erodes through the wall.
Recognizing the Acute Warning Signs
The hallmark symptom of a stomach rupture is the sudden, catastrophic onset of severe abdominal pain. Patients describe this sensation as a sharp, stabbing pain that begins abruptly and is immediately overwhelming. The pain starts in the upper abdomen but quickly spreads across the entire peritoneal cavity as stomach contents contaminate the area.
This widespread inflammation leads to abdominal rigidity, often described as a “board-like” abdomen. The involuntary tensing of the abdominal muscles is a classic physical sign of peritonitis. Any movement, including coughing or deep breathing, significantly intensifies the patient’s distress.
Systemic signs of infection and shock quickly follow if treatment is delayed. These symptoms include a rapid heart rate, a drop in blood pressure, fever, or chills. Nausea and vomiting are also common. The combination of severe, sudden pain and these systemic signs requires immediate emergency medical attention.
Emergency Stabilization and Surgical Repair
Upon arrival at the hospital, the immediate focus is aggressive patient stabilization before surgery. This involves fluid resuscitation with intravenous (IV) fluids to counteract shock and the immediate administration of broad-spectrum antibiotics. Antibiotics are crucial to prevent the progression of peritonitis to sepsis, a major cause of death.
Diagnosis is often confirmed quickly using imaging studies, particularly an upright chest X-ray or a computed tomography (CT) scan. The definitive sign is the visualization of “free air” under the diaphragm (pneumoperitoneum), confirming that gas has leaked from the gastrointestinal tract. Once established, the patient is rushed to the operating room.
Emergency surgical intervention is the only curative treatment for gastric perforation. The procedure is typically performed as an open exploratory laparotomy or, if the patient is stable, a less invasive laparoscopy. The primary goals are to locate the perforation, close the hole, and thoroughly clean the abdominal cavity of leaked gastric contents.
The standard repair technique for a simple ulcer perforation is primary closure, often reinforced with a patch of omentum (a fatty tissue). This reinforcement is commonly known as a Graham patch. If the perforation is very large, the tissue is severely damaged, or malignancy is suspected, the surgeon may perform a partial gastrectomy, removing a portion of the stomach.
Post-Surgical Recovery and Long-Term Outlook
Following surgical repair, patients require intensive monitoring, often in an intensive care unit, to watch for complications. The most significant immediate risk is the development of sepsis, which can cause multi-organ failure. Patients are initially kept NPO (nothing by mouth) and receive nutrition and fluids intravenously until the surgical site begins to heal.
For individuals who presented early and were not septic, the hospital stay may be relatively short, allowing them to resume oral intake within a few days. Those who presented late, especially with severe infection or multiple comorbidities, face a more protracted recovery involving longer stays and intensive care. Returning to normal activities typically spans several weeks to a few months.
The long-term outlook is heavily influenced by the time elapsed between the rupture and surgical repair. Patients who experience postoperative complications, such as wound infections or abscesses, may have a reduced long-term survival rate. To prevent recurrence, patients whose perforation was caused by an ulcer must receive ongoing medical management, including proton pump inhibitors (PPIs) and H. pylori eradication therapy.