What Causes Gastric Perforation?

Gastric perforation is, in fact, quite common in clinical practice. It may result either from underlying disease or from iatrogenic causes. Let us first discuss iatrogenic gastric perforation—for instance, that occurring during routine gastroscopy or other surgical procedures. This constitutes one category of gastric perforation.

Secondly, numerous diseases can cause gastric perforation. Which conditions are implicated? First, peptic ulcer disease may lead to gastric perforation. However, with the widespread use of acid-suppressing agents today, perforations secondary to peptic ulcers have become relatively rare.

Second, gastric cancer—particularly the ulcerative type—can also cause perforation. This is clinically common. For example, if a patient presents with long-standing abdominal pain and rapidly develops signs of peritoneal irritation, perforation should be strongly suspected.

Third, another iatrogenic factor includes prolonged oral intake of nonsteroidal anti-inflammatory drugs (NSAIDs), which may also precipitate gastric perforation. Clinicians must remain vigilant for this possibility.

Additionally, some patients do not take medications for joint pain but instead consume “headache powder”—a compound analgesic largely abandoned in modern clinical practice—which can likewise induce gastrointestinal perforation.

Furthermore, other gastric or extragastric conditions may also lead to perforation. Examples include abdominal wall infections, cholecystitis, and acute pancreatitis—all of which may compromise gastric wall integrity and result in perforation. Thus, the etiology of gastric perforation is highly complex, necessitating careful clinical differentiation to ensure accurate diagnosis.