Peptic ulcers, erosions caused by stomach acid that occur in the stomach or duodenum, the first part of the small intestine, affect half a million Americans each year, Baylor College of Medicine reports. Peptic ulcers, most often caused by bacteria called Helicobacter pylori or by non-steroidal anti-inflammatory medications that irritate the stomach lining, can perforate or eat completely through the lining of the stomach or intestine, causing pain, nausea and vomiting. Infection of the abdominal cavity, peritonitis, generally follows and requires prompt treatment.
Medications
Medications help heal the perforated ulcer and also treat infection in the abdominal cavity, the peritoneum and H pylori infection, if present. Intravenous antibiotics cure H pylori infection and prevent serious complications of peritonitis. Medications called proton pump inhibitors, or PPIs, decrease acid production and promote rapid ulcer healing, the Merck Manual states. Histamine-2, also known as H-2 blockers also reduce stomach acid production and healing, but less effectively than PPI medications. PPIs and H-2 blockers are given intravenously if perforation has already occurred. Morphine or other narcotic pain medications are also given by injection or intravenously.
Surgery
Some patients with perforated peptic ulcers require surgery; others do not. Surgery can be done laparoscopically, through a small incision, or through a large abdominal incision, or laparatomy. Non-surgical management and observation may be a reasonable initial treatment, except in patients over age 70, Emergency Medicine counsels, since 2/3 of patients over 70 need emergency surgery. Several different variations of surgery are used to treat perforation, including highly selective vagotomy, cutting part of the vagus nerve to decrease acid production; vagotomy with antrectomy, removal of the antrum, part of the stomach that promotes acid production; or partial gastrectomy, or stomach removal.
Other Treatments
Other treatments for perforated ulcer include continuous nasogastric surgery to keep the stomach and small intestines empty and peritoneal lavage. Intravenous fluids and electrolytes are necessary for hydration and nutrition, since no food is allowed until the stomach heals.
