Gastric Perforation
- All ulcers should be biopsied, because malignancy must be ruled out.
- If the patient is stable, a resection of the ulcer can be performed depending on the location.
- An antrectomy is performed for lower ulcers, including vagotomy for type II and type III ulcers, with reconstruction.
- For perforated ulcers closer to the GE junction, wedge or total/subtotal gastrectomy is performed with reconstruction.
- If the patient is unstable, biopsy and source control with an omental patch may be all that is tolerated.
- Treatment is based on type:
- Type I: wedge resection or antrectomy with Billroth I anastomosis.
- Types II and III: distal gastrectomy with truncal vagotomy due to increased acid levels.
- Type IV: depends on the size and distance from the GE junction; distal gastrectomy, subtotal, or total gastrectomy