Perforated duodenal ulcer: Emerging pattern (original) (raw)

A Clinical Study of Duodenal Ulcer Perforation

Background: Perforation of the duodenal ulcer is one of the commonest and lethal complications of chronic duodenal ulcer. 2-10% of peptic ulcer may perforate. Unless prompt diagnosis is made and early active surgical management is done the mortality rate is very high upto10%. It is the commonest cause of death resulting from surgical abdominal emergency next to intestinal obstruction only. Despite this and recent advances in both diagnosis and management of peptic ulcer disease, namely the improvement in endoscopic facilities, eradication of H. pylori and the introduction of the proton pump inhibitors, complications such as peptic ulcer perforation remain a substantial healthcare problem. This may be due to an increase in the risk factors for peptic ulcer complications. With this statistics , a study for clinical presentations, complications and incidence of peptic ulcer perforation was carried out to know the trends in population of the region. Materials and Methods: Prospective study was conducted for period of 2 years from September 2015 to August 2017 on patients admitted in the Surgical Wards of Regional Institute of Medical Sciences, Imphal, with the diagnosis of duodenal ulcer perforation. Data was collected on various variables like age and sex incidence, occupation, clinical features, association with smoking and alcohol, investigations, size and site of perforation, post-operative complications and condition at follow-up. Results: Of the 110 patients studied 106(96.3%) were males and 41-50 years was the most common age group. Majority (80%) belong to laborious workers commonly associated with alcohol intake and smoking. Pain was the most consistent symptom while guarding (89.1%), tenderness (81.8%) and obliteration of liver dullness(76.4%)were the most important signs present. Gas under the diaphragm was present in 97.3% of patients. Pre-operative shock, old age, longer duration of perforation, concurrent medical illness and higher grade of peritoneal contamination are the main factors affecting the morbidity and mortality in duodenal ulcer perforation. Mortality rate was 6.4% in this study. Simple closure with Graham's omentopexy followed by proton pump inhibitor drugs is an effective treatment procedure for duodenal ulcer perforation. H. pylori eradication after simple closure may be necessary to prevent recurrence of ulcer.

Demographic, Clinico-Pathological Study And Management of Peptic Ulcer Perforation

Introduction: Peptic ulcer disease (PUD) is a worldwide health problem because of its high morbidity, mortality and monetary loss. The incidence of uncomplicated peptic ulcer disease has lowered dramatically due to usage of proton pump inhibitors and H 2 receptor antagonists. Complicated peptic ulcer disease is still a concern all over the world and perforation is the most common complication followed by bleeding. Material and Methods: This is a retrospective/prospective study of 60 cases of peptic ulcer perforation carried out in MediCiti institute of Medical science, from July 2012 to September 2017. Out of 60 peptic ulcer perforations, 51(85%) were males and 9 (15%) were female showing strong male predominance with male: female ratio 5.66:1. More number of cases observed in 5 th decade followed by 3 rd , 6 th &7 th decade. 45 patients (75%) had h/o alcohol consumption and 35 patients (58.33%) had smoking history. 15 patients (25%) had h/o peptic ulcer disease and10 patients (16.66) had h/o taking NSAIDs. All the cases presented with pain abdomen (100%) followed by vomiting (55%) and distension (33.33%). Gas under diaphragm was present in all the cases (100%). 1 st part of the duodenum was most common site of perforation followed by pre pyloric part of the stomach. Laporotomy and closure perforation was done by open methods with a mortality rate of 3.33%. The aim of our study is to share our experience to evaluate demographic values and risk factors for perforated peptic ulcer and to find out the mortality rate.

A Clinicopathological Study of H. Pylori and Perforated Peptic Ulcer

IOSR Journals , 2019

Background and objectives:Peptic perforation is one of the common complications of peptic ulcer disease. H. pylori and NSAIDs accounts for most of them. This complication of peptic ulcer disease represents a surgical emergency. Eradication of H. pylori in patients with peptic ulcer disease is associated with reduced incidence of complication and recurrence of disease. This study aims to find out a relation in the study population between perforation peritonitis and H. pylori. Methods: A total of 50 cases of perforation peritonitis were taken for study during period Mar. 2016 to Sept. 2017. The relation of perforated peptic ulcer with age, sex, H. pylori infection, h/o peptic ulcer symptoms, NSAIDs intake, alcohol and smoking was studied. Along with this relation of H. pylori with each individual parameter like age, sex etc. also studied. Rapid urease test was performed on biopsy specimen from margin of perforation. Another biopsy specimen was sent for histological examination. Those who were positive were treated with anti H. pylori therapy for 14 days. Results: The mean age of the study subjects was found to be 42.48 ± 16.6 (mean ± SD) with a range of 17-75 years. 80% of perforated peptic ulcer were positive for H. pylori. Maximum number (74%) of perforated peptic ulcer cases were present in  50 years age group and 86.5% were males.The most common site of perforation was 1 st part of duodenum (96%) followed by antral (4%). Conclusion: H. pylori is still the common cause of perforated peptic ulcer. Males are most commonly affected. The most common site of perforation is 1 st part of duodenum.

Study of various clinical parameters in peptic ulcer perforation and its relation with outcome

IP Innovative Publication Pvt. Ltd., 2017

Introduction: To evaluate the age and sex incidence, associated clinical history, risk factor involved, time of surgical intervention done after the onset of illness, postoperative complication, total duration of hospital stay, mortality and its relation with outcome of the patient. Materials and Method: This study has been based on analysis 100 cases of peptic ulcer perforation (gastric and duodenal) admitted in M.L.B. Medical College, Jhansi from March 2014 to December 2015. The cases were collected at random, which were admitted in emergency and treated in various surgical units. After admission a detailed history was taken and clinical examination was done and possible immediate investigations were done. All 100 cases admitted, and were subjected to emergency laprotomy. At the time of laprotomy, the site of perforation, size of perforation, nature of peritoneal fluid, peritoneal fluid culture and amount of peritoneal contamination were determined. All cases have been treated by simple closure with grahm omental patch repair. Summary and Conclusion: Peptic ulcer perforation (Acid peptic disease) is one of the common acute abdominal emergencies, The peak incidence was between 41-50 years age groups, Smoking and NSAIDS was commonest risk factor for peptic ulcer perforation. In most of the patients operative time was 1-2 hrs. Most patients have bilious intraperitoneal fluid and culture was sterile. Outcome was good in most of the post-op cases who have no complication and discharge satisfactorily from hospital within 8-10 days of normal hospital stay.

A Study of various clinical parameters in peptic ulcer perforation and its relation with outcome

Background: Every year peptic ulcer disease affects 4 million people around the world. Perforation is the most important complication of peptic ulcer disease. Ulcer perforation was a lethal disease until surgical treatment was introduced. Objectives: This study was performed to evaluate the age and sex incidence, associated clinical history, risk factor involved, time of surgical intervention done after the onset of illness, postoperative complication, total duration of hospital stay, mortality and its relation with outcome of the patient. Material and Methods: This is a cross-sectional study, which was conducted from March 2014 until December 2014 at BRD Medical College, Gorakhpur. This study was performed to assess the demographic distribution of peptic ulcer, a detailed history was taken and clinical examination of the patient was carried out at the time of admission. X-ray abdomen erect posture, leukocyte count, serum amylase were performed along with other investigations. After surgery, site of perforation type of surgery along with any complications and outcome of treatment were recorded. Patients were followed-up for 30 days. Results: A total of 100 patients were studied with men and women ratio of 13.3:1. Most common age group was the 41-50 years, while most common symptom was abdominal pain. X-ray abdomen erect showed gas under diaphragm in 96% patients and leukocytosis was present in 83% of cases. Duodenal perforations (64%) were more common than gastric perforations (36%). Simple closure with omental patch (98%) was the most common surgical method employed. Wound sepsis (22%) was the most common complication. Conclusion: Perforation of peptic ulcer is one of the most common causes which require emergency laparotomy. Duodenum and pylorus are commonly involved and simple closure with omental patch was effective. Early operation is the key to successful treatment and minimizes mortality.

Considerations in the Management of Perforated Peptic Ulcers

Surgical Clinics of North America, 1976

Acute perforation of a peptic ulcer may be a life-threatening abdominal catastrophe that in usual circumstances can be easily diagnosed and treated. The etiology of perforated duodenal ulcers is unknown, but stress, alcohol, and salicylates have been implicated. Thirty to 50 per cent of patients with perforated duodenal ulcers have no history of duodenal ulcer disease or ingestion of alcohol or salicylates. Most perforations occur a few hours after meals, and whether gastric hypersecretion is important is unknown. Treatment can be medical or surgical depending on the patient's age, duration of perforation, previous ulcer symptoms, and general medical condition. As in other types of surgery, the best approach is individualized, so that treatment effectively alleviates the problem and yields the best long-term results with minimal morbidity and mortality. We review the clinical presentation, diagnosis, and treatment of perforated peptic ulcer. Criteria that determine which operation should be done for a perforated peptic ulcer are presented.

Prevalence of H.Pylori in Duodenal Ulcer perforation, Mayo Hospital Experience

BACKGROUND Duodenal ulcer perforation is among common surgical emergencies. Recent data suggests that more than 99% of all duodenal ulcers having infection with H. pylori is associated with use of NSAIDS. There is a necessity to study the association of H. pylori infection with perforated duodenal ulcers. If proved, control of H. pylori may reduce this catastrophe and burden on the society.

Changing patterns in the surgical treatment of perforated duodenal ulcer – single centre experience

Videosurgery and Other Miniinvasive Techniques, 2015

Introduction: Although the surgical treatment of patients with perforated duodenal ulcer is the method of choice, the introduction of effective pharmacotherapy has changed the surgical strategy. Nowadays less extensive procedures are chosen more frequently. The introduction of laparoscopic procedures had a significant impact on treatment results. Aim: To present our experience in the treatment of perforated duodenal ulcer in two periods, by comparing open radical anti-ulcer procedures with laparoscopic ulcer repair. Material and methods: The analysis covered patients operated on for perforated duodenal ulcer. Two groups of patients were compared. Group 1 included 245 patients operated on in the period 1980-1994 with a traditional method (pyloroplasty + vagotomy) before introduction of proton pump inhibitors (PPI). Group 2 included 106 patients treated in the period 2000-2014 with the laparoscopic technique supplemented with PPI therapy. Groups were compared in terms of patients' demographic structure, operative time, complication rate and mortality. Results: The mean operative time in group 1 was shorter than in group 2 (p < 0.0001). Complications were noted in 57 (23.3%) patients in group 1 and 14 (13.5%) patients in group 2 (p = 0.0312). Reoperation was necessary in 13 (5.3%) cases in group 1 and in 5 cases in group 2 (p = 0.8179). The mortality rate in group 1 was significantly higher than in group 2 (10.2% vs. 2.8%, p = 0.0192). In group 1, median length of hospital stay was 9 days and differed significantly from group 2 (6 days, p < 0.0001). Conclusions: Within the last 30 years, significant changes in treatment of perforated peptic ulcer (PPU) have occurred, mainly related to abandoning routine radical anti-ulcer procedures and replacing the open technique with minimally invasive surgery. Thus it was possible to improve treatment results by reducing complication and mortality rates, and shortening the length of hospital stay. Although the laparoscopic operation is longer, it improves outcomes. In the authors' opinion, in each patient with suspected peptic ulcer perforation, laparoscopy should be the method of choice.

H. pylori and peptic ulcer perforation: prevalence of infection and role in surgical outcome

International Surgery Journal

Background: Perforated peptic ulcer is one of the most common surgical emergencies. Despite a definite association of H. pylori with peptic ulcer disease, its association with peptic ulcer perforation is still doubtful. The aim of the present study was to know the prevalence of H. pylori infection and its role in surgical outcome of patients.Methods: This prospective observational study was carried out at a tertiary care hospital of north India for a period of two years and included 136 consecutive patients of perforated peptic ulcer who underwent emergency laparotomy. H. pylori infection was tested on ulcer margin biopsy using rapid urease test kit and confirmed on histopathological examination.Results: 136 consecutive patients of perforated peptic ulcer were included in this study with mean age of 42.43 years and sex ratio of 11.4:1. H. pylori infection was present in fifty four percent (54%) of patients. There was no relationship of H. pylori infection with morbidity and mortalit...