Is an upper gastrointestinal perforation serious?

Written by Ren Zheng Xin
Gastroenterology
Updated on May 13, 2025
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Upper gastrointestinal perforation is most commonly due to gastric perforation caused by gastric ulcers and is considered an emergency in clinical settings. Following the perforation, the contents of the stomach leak into the abdominal cavity, causing diffuse peritonitis and potentially leading to shock; urgent perforation repair surgery is required. If the perforation is caused by a large ulcer, a major part of the stomach may be removed to prevent recurrence of the ulcer. After surgery, it is important to enhance fluid support. If there is a significant peritonitis, timely use of antibiotics is necessary. Post-surgery, it is crucial to rest, focus on dietary adjustments, eat more vegetables and fruits, and consume fewer spicy and greasy foods. (Medication should be taken under the guidance of a doctor.)

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Written by Ren Zheng Xin
Gastroenterology
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Upper gastrointestinal hemorrhage rescue process

First, it is important to address the most life-threatening situations by promptly clearing the airway to prevent blood clots from gastrointestinal bleeding from blocking the bronchi, which can cause choking or asphyxiation. Additionally, it is crucial to timely replenish blood volume, as significant blood loss can directly lead to shock. While combating shock, actively identify the cause of the bleeding. Use a gastroscope for examination, and blood can be stopped under gastroscopy. If it cannot be stopped under gastroscopy, an emergency laparotomy should be performed to carry out a major gastrectomy. Postoperatively, intensive care should be strengthened, actively identifying the cause of gastric bleeding, providing symptomatic treatment, and maintaining regular dietary habits, with meals being on schedule and in fixed amounts.

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Written by Wang Li Bing
Intensive Care Medicine Department
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Upper gastrointestinal bleeding includes which areas?

In clinical practice, bleeding in the digestive system above the ligament of Treitz is referred to as upper gastrointestinal bleeding. It primarily includes the following areas: The first major category is esophageal diseases, such as esophagitis, esophageal trauma, and other causes of bleeding. The second category is duodenal diseases, such as peptic ulcers, acute erosive hemorrhagic gastritis, stomach cancer, etc. Another cause is liver cirrhosis leading to portal hypertension, which can cause rupture and bleeding in esophageal and gastric varices. The fourth category includes biliary system and pancreatic diseases involving the duodenum, such as pancreatic cancer, which can also lead to bleeding.

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Written by Wang Li Bing
Intensive Care Medicine Department
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Common Causes of Upper Gastrointestinal Bleeding

The common causes of upper gastrointestinal bleeding mainly include the following points: First, esophageal diseases, such as esophagitis, Mallory-Weiss syndrome. Secondly, peptic ulcers, gastric cancer, acute erosive hemorrhagic gastritis, and then esophageal gastric variceal rupture caused by portal hypertension. There are also diseases of neighboring organs or tissues of the upper digestive tract, such as biliary bleeding, pancreatic diseases involving the duodenum, such as pancreatic cancer, acute pancreatitis complicated by abscess rupture and bleeding. Additionally, there are systemic diseases, such as allergic purpura, hemophilia, leukemia, etc.

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Written by Wang Li Bing
Intensive Care Medicine Department
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The most common symptom of upper gastrointestinal bleeding

The most common symptoms of upper gastrointestinal bleeding mainly include: vomiting blood, black stools, or symptoms such as dizziness, palpitations, and fatigue, and even hypovolemic shock and hypovolemic anemia, etc. Therefore, when gastrointestinal bleeding occurs, if the patient has a large amount of bleeding and the bleeding is rapid, it is necessary to seek medical attention promptly, to administer fluid replenishment, volume expansion, and blood transfusion to replenish blood volume, along with symptomatic treatment such as medication and endoscopic hemostasis. If conservative treatment is ineffective, surgical treatment may be considered to avoid life-threatening risks.

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Written by Zhu Dan Hua
Gastroenterology
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Clinical manifestations of upper gastrointestinal bleeding

Patients with upper gastrointestinal bleeding typically present with vomiting blood or bleeding from the stool. Of course, if the bleeding amount is small, there may be no other discomfort. However, if the bleeding is significant, symptoms may include dizziness, fatigue, chest tightness, and palpitations related to low blood volume. Some patients might also experience abdominal discomfort, such as abdominal pain, bloating, or even indigestion. For those suspected of upper gastrointestinal bleeding, it is advisable to further complete blood tests, stool analysis, and electrocardiograms. It is necessary to promptly carry out a gastroscopy when needed to clarify the cause of the bleeding, and consider if it is due to ulcers or vascular malformations. In the early stages of treatment, symptomatic management should be prioritized, and patients are advised to actively rehydrate to improve symptoms of low blood volume and to transfuse red blood cells if necessary to correct anemia. Once the cause is identified, causative treatment should be added, such as the use of acid-suppressing and gastric-protecting drugs for bleeding associated with peptic ulcers. (The use of medications should be under the guidance of a doctor.)