The stomach is prone to a host of disturbances and diseases as is most parts of the gastrointestinal tract. One of the differences with the stomach lies the strong gastric acid and digestive enzymes which the stomach has to produce and contain. At times these substances may also prove harmful to the stomach itself and can give rise to various conditions, some of which may lead to complications like a rupture of the stomach.
It is important to note that a tear in the abdominal muscles or an abdominal hernia may sometimes be incorrectly referred to as a torn stomach.
What is a torn stomach?
There are many conditions where tears can occur in the stomach. Since the stomach is a hollow sac, these tears occur in the stomach wall. In some conditions the tears can be superficial, while in other cases it can be deep. There are also instances where the tear may penetrate through the entire wall of the stomach thereby allowing the stomach contents to leak out into the abdominal cavity.
The three main conditions which may be considered as a tear in the stomach is erosive gastritis, a perforated stomach ulcer and a Mallory-Weiss tear. Some of these conditions can affect any person, even if the stomach was previously unaffected with any underlying diseases. Other conditions arises with severe or prolonged stomach diseases which can lead to weakening of the stomach wall.
Causes of Stomach Tears
The causes of each condition is discussed in detail below. There are some common causes among most of these conditions, such as gastritis. There may also be common risk factors with advancing age being the more likely risk factor. Usually these causes and risk factors lead to a weakness of the stomach wall which increases the likelihood of tears forming.
Gastritis is a condition where the stomach wall is inflamed. One type is erosive gastritis where the wall of the stomach is eroded. Deeper erosions are referred to as ulcers. Although these erosions may not be tears through the depth of the stomach wall, it is nevertheless a breakdown of the wall structure. In some cases deeper erosions can eventually lead to a full tear.
There are many different causes of gastritis but H.pylori infection and excessive NSAID (non-steroidal anti-inflammatory drugs) use are the two most common causes. In severe cases there may be bleeding from the erosion or ulcer as well. Other risk factors for developing gastritis includes older age, stress, excessive alcohol use, HIV infection, inflammatory bowel disease (specifically Crohn’s disease) and autoimmune factors.
A perforated ulcer is a complication where a stomach ulcer tears through the stomach wall. It is an uncommon complication of peptic ulcer disease but can occur in severe cases. When minor the perforation (hole) may heal on its own but surgery is necessary for a major perforation. If left untreated, a perforated ulcer can lead to complications which can be life-threatening.
The cause of a perforated ulcer is largely the same as gastritis. Genetic factors and tobacco use may also play a role in the development of a perforation. Patients with underlying gastrointestinal disorders may be at a greater risk of a perforation. However, the exact reason why a perforation may occur in some cases of severe gastritic and peptic ulcer disease is not always clear.
A Mallory-Weiss tear is a break in the wall of the esophagus or stomach. It occurs in the lower part of the esophagus and/or the upper part of the stomach, where the esophagus and stomach meet. In this type of tear, the laceration is longitudinal and is usually limited to the inner layers of the esophageal and stomach wall. The condition is usually acute and often heals on its own within a few days.
The cause of a Mallory-Weiss tear is any significant force to the upper gastrointestinal tract like with vomiting or retching. It can also occur with persistent coughing, severe hiccups, blunt force trauma and excessive screaming. Usually there is some underlying condition in the latter causes. This may include a hiatal hernia, esophagitis, gastroenteritis and gastrointestinal obstruction.
Signs and Symptoms
Some of the common symptoms among the different types of stomach tears includes:
- Nausea of varying intensity but is usually severe.
- Vomiting of blood, sometimes fresh blood or dried blood (coffee ground appearance).
- Abdominal pain, upper abdominal pain usually to the left side.
- Gnawing, burning and/or sharp stomach pain.
- Melena – dark, tarry stools due to upper gastrointestinal bleeding.
- Bloating and indigestion or non-specific discomfort in the stomach region.
The other signs or symptoms that are often associated with complications include:
- Severe abdominal pain and tenderness
- Rapid heart rate and low blood pressure
- Abdominal distension
It is uncommon for any tear to be silent but can at times be masked to some degree with the use of certain drugs and substances like alcohol.
Treatment of a Torn Stomach
With some causes of a torn stomach, no treatment is necessary and the tear will heal with just supportive measures. However, a tear is usually serious and often a complication so medical or surgical treatment may be necessary. It is also required when there is a risk of complications like peritonitis. The choice of treatment depends on a host of factors including the underlying causative condition, severity of the condition and risk of complications.
- Proton pump inhibitors (PPIs) and H2-blockers are the main drugs used to suppress gastric acid and used for conditions like gastritis.
- Anti-emetic drugs are used for conditions like Mallory-Weiss tears to stop the vomiting and allow the area to heal.
- Analgesics may sometimes be prescribed for pain control.
- Endoscopic hemostasis may be necessary to seal off ruptured blood vessels where bleeding is significant.
- Various surgical procedures may be necessary for a perforated ulcer. This may include procedures such as a pyroplasty, vagotomy or antrectomy.
Any tear, irrespective of the depth, should be treated as an emergency and investigated immediately. While some minor tears may resolve spontaneously, it has to first be assessed by a medical professional. Various supportive measures may need to be implemented in order to facilitate healing.