Emergency Surgery After Silent Stomach Perforation
A 70-year-old patient named Müşerref Gençcan underwent emergency abdominal surgery after doctors at Biruni University Medical Faculty Hospital discovered a severe stomach perforation that had leaked contents into her abdominal cavity, İHA reported. Gençcan arrived at the hospital experiencing nausea and vomiting, having avoided medical consultations for a prolonged period. Clinical evaluations revealed a blood glucose level in the 400s and an HbA1c measurement of 13.6 percent, indicating severe long-term hyperglycemia.
Clinical Findings at Biruni University Hospital
Internal Medicine Specialist Dr. Muhammet Bilici noted that Gençcan was transferred from another facility with high blood sugar and elevated infection markers but displayed no sore throat, cough, diarrhea, or urinary tract symptoms. Diagnostic imaging subsequently revealed a gastric perforation. Bilici explained that long-term uncontrolled diabetes can damage nerves and blood vessels, a condition known as diabetic neuropathy. This nerve damage likely dulled Gençcan’s pain perception, preventing the severe pain that normally accompanies a stomach perforation.
General Surgery Specialist Dr. Ramazan Acıroğlu confirmed that computed tomography scans verified the rupture, prompting an immediate transfer to the operating room. During the procedure, surgical teams found that gastric contents had spilled into the peritoneal cavity and affected part of the liver. Surgeons cleaned the accumulated fluid from the abdominal cavity and repaired the perforated area. Doctors estimated that the perforation had likely occurred three to five days prior to admission, noting that the condition was life-threatening and could have become fatal without timely intervention.
Bilici stated that he encountered a stomach perforation progressing without severe abdominal pain for the first time in his clinic, noting that such a presentation is uncommon. He added that if the patient had not received intervention on the same day, her blood pressure could have dropped, her general condition could have deteriorated, and a life-threatening situation with a need for intensive care could have developed.
Discussing the broader effects of diabetes, Bilici noted that diabetes can cause slowed stomach and intestinal movements, gastroparesis, diarrhea, and constipation. He also remarked that serious intra-abdominal diseases in elderly patients do not always present with typical symptoms.
Hospital Visit Follows Worsening Vomiting Symptoms
Reflecting on her reluctance to seek medical care, Gençcan explained that she historically avoided hospitals because of a fear of doctors. She stated that worsening vomiting eventually led her to tell her children to take her to the hospital, noting that she was unaware of the extent of her internal damage until after the operation. Following the primary repair, Gençcan spent approximately one week in the intensive care unit receiving intravenous antibiotic therapy to control the abdominal infection.
Medical staff planned further diagnostic evaluations to identify the underlying trigger of the gastric rupture. Acıroğlu stated that Gençcan would undergo an endoscopy approximately one to one-and-a-half months after discharge to investigate the ulcer that caused the perforation and assess whether another cause, especially a tumor, was present.
Frequently Asked Questions About The Istanbul Case
Why didn’t Müşerref Gençcan feel severe abdominal pain when her stomach perforated?
Internal Medicine Specialist Dr. Muhammet Bilici attributed the lack of typical symptoms to diabetic neuropathy. Chronic hyperglycemia can damage peripheral nerves over time, blunting pain reception and masking the severe pain usually associated with a stomach perforation.
How long had the stomach rupture gone unnoticed before surgery?
Doctors estimated that the gastric perforation had developed approximately three to five days prior to the emergency operation at Biruni University Medical Faculty Hospital.
What specific diabetes markers were recorded upon her hospital admission?
Clinical assessments showed Gençcan’s blood glucose levels running in the 400s alongside an HbA1c value of 13.6 percent.