P-EGS26 Outcomes of Surgical Treatment for Perforated Peptic Ulcer in a non-Upper Gastrointestinal Surgery Centre

Abstract Background Perforated peptic ulcer (PPU) remains a common surgical emergency worldwide requiring surgical intervention. Although commonly performed, morbidity and mortality rate remained high. This study aimed to analyze the factors that contribute to the outcome of PPU surgery in a non-upper gastrointestinal surgery center in Malaysia. Methods Data were collected by retrospective review of all PPU surgeries done throughout the year 2020, looking into various preoperative, intraoperative, and postoperative details. Results In this study, we have a total of 24 PPU patients underwent surgery resulted in 7 (29.2%) deaths. Majority of our subjects were elderly (median age 65 years, IQR 48.5 – 73.0) with 4 (16%) being of ASA (American Society of Anesthesiologist) category 3 - 4. The most common cause of death was uncontrolled systemic infection in 4 patients (57.1%), followed by 2 (28.6%) fatal arrhythmia and 1 (14.3%) massive upper gastrointestinal bleed. Our analysis found that size of perforation ≥ 30mm (OR = 0.18, 95%CI 0.08 - 0.44), and postoperative complications (OR = 12.5, 95%CI 1.6 – 97.6) were significantly associated with a higher postoperative death. Low serum albumin level (mean 34.3 ± 9.1g/L), negative base excess level (mean -3.28 ± 4.89), and prolonged interval between admission and commencement of surgery (median 750 mins, IQR 258 – 2218) were all significantly associated with increased mortality post PPU surgeries. Conclusions This study highlighted to us various perioperative factors which could potentially be modifiable thus necessary measures can be taken in the future to ensure a better operative outcome of PPU surgery.

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Upper gastrointestinal surgery

10.1093/med/9780198510567.003.0006 ◽

2011 ◽

Author(s):

Y. K. S. Viswanath ◽

S. Dresner

Keyword(s):

Gastric Cancer ◽

Morbid Obesity ◽

Peptic Ulcer ◽

Peptic Ulcer Disease ◽

Radical Surgery ◽

Gastrointestinal Surgery ◽

Perforated Peptic Ulcer ◽

Open Splenectomy ◽

Ulcer Disease ◽

Upper Gastrointestinal

Bleeding peptic ulcer disease 186Perforated peptic ulcer disease 188Oesophageal rupture and perforation 190Gastro-oesophageal reflux disease 192Para-oesophageal hiatus hernia repair 194Open (Heller's) cardiomyotomy for achalasia 196Open splenectomy 198Weight reduction surgery for morbid obesity 200Radical surgery for gastric cancer ...

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Upper gastrointestinal surgery

10.1093/med/9780199608911.003.0002 ◽

2017 ◽

Author(s):

Anil Agarwal ◽

Neil Borley ◽

Greg McLatchie

Keyword(s):

Peptic Ulcer ◽

Adjustable Gastric Banding ◽

Gastrointestinal Surgery ◽

Subtotal Gastrectomy ◽

Perforated Peptic Ulcer ◽

Regional Lymph Nodes ◽

T Tube ◽

Upper Gastrointestinal ◽

Tube Repair

This chapter covers oesophago-gastro-duodenoscopy, including operations like perforated peptic ulcer closure, laparoscopic cholecystectomy, surgery for bleeding peptic ulcer, antireflex surgery—Nissen, Dor, Toupet. It gives a classification of regional lymph nodes of the stomach and explains lymphadenectomy, and the steps of total and subtotal gastrectomy. Types of oesophagectomy and the steps of operations are explained. Details of the operative steps of Heller’s cardiomyotomy for achalasia are provided. Obesity surgery includes laparoscopic adjustable gastric banding (LAGB), sleeve gastrectomy (LSG), and Roux-en-Y gastric bypass (RYGB). Managing oesophageal rupture and perforation includes non-operative and surgical and T tube repair.

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Spectrum of upper gastrointestinal bleed in patients with cirrhosis of liver

Journal of College of Medical Sciences-Nepal ◽

10.3126/jcmsn.v13i3.17938 ◽

2017 ◽

Vol 13 (3) ◽

pp. 318-322

Author(s):

Subash Bhattarai ◽

Khus Raj Dewan ◽

Gaurav Shrestha ◽

Bhanumati Saikia Patowary

Keyword(s):

Liver Cirrhosis ◽

Peptic Ulcer ◽

Portal Hypertension ◽

Oesophageal Varices ◽

Gastrointestinal Bleed ◽

Variceal Bleed ◽

Upper Gastrointestinal Bleed ◽

Cirrhotic Patients ◽

Cirrhosis Of Liver ◽

Upper Gastrointestinal

Background & Objectives:Acute upper gastrointestinal (UGI) bleeding is a serious medical problem in patients with cirrhosis of liver associated with high mortality. Gastro-oesophageal variceal bleed is the most common complication of portal hypertension in patient with liver cirrhosis. This study was undertaken to establish the causes of UGI bleed in cirrhosis, their relative incidences, clinical presentation , endoscopic findings, outcomes during hospitalization including rebleeding and mortality were studied.Materials & Methods:One hundred and twenty patients with clinical features, sonological and endoscopic evidence of portal hypertension and cirrhosis of liver who presented with upper gastrointestinal bleed were included in the study. After haemodynamic stability, each patient underwent UGI endoscopy usually within 12 hours and the aetiology with diagnostic findings were documented. Results:Ruptured oesophageal varices was the most common cause of UGI bleed in cirrhotic patients. Non variceal causes of UGI bleed accounted for 33.3 % of cases. The majority of non variceal bleed was peptic ulcer disease and accounted for 19.2 % of total UGI bleed in liver cirrhosis. This was followed by portal hypertension gastropathy, erosive gastropathy, mallory-weiss tear and others.Conclusion:The most frequent causes of acute gastrointestinal bleeding in cirrhosis was oesophageal varices. Peptic ulcer disesase is also a common aetiology of UGI bleed in cirrhosis. Cirrhotic patients with variceal etiology have more chances of rebleeding and have higher mortality than those with non variceal aetiologies.

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Upper gastrointestinal surgery

10.1093/med/9780198799481.003.0008 ◽

2021 ◽

pp. 365-404

Keyword(s):

Morbid Obesity ◽

Peptic Ulcer ◽

Small Bowel ◽

Hiatus Hernia ◽

Gastrointestinal Surgery ◽

Upper Gastrointestinal Endoscopy ◽

Intestinal Ischaemia ◽

Ulcer Disease ◽

Small Bowel Tumours ◽

Upper Gastrointestinal

This chapter outlines the assessment and management of the patient who presents with dysphagia, haematemesis and upper gastrointestinal perforation. The conditions commonly affecting the oesophagus, stomach, duodenum, jejunum and ileum are described; oesophageal motility disorders, pharyngeal pouch, hiatus hernia, gastro-oesphageal reflux disease, oesophageal tumours, peptic ulcer disease, gastric tumours, chronic intestinal ischaemia and small bowel tumours. Procedures such as upper gastrointestinal endoscopy and surgery for morbid obesity are also discussed in this chapter.

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Prognostic Factors in Peptic Ulcer Perforations: A Retrospective 14-Year Study

International Surgery ◽

10.9738/intsurg-d-14-00187.1 ◽

2015 ◽

Vol 100 (5) ◽

pp. 942-948 ◽

Cited By ~ 5

Author(s):

Mutlu Unver ◽

Özgür Fırat ◽

Ömer Vedat Ünalp ◽

Alper Uğuz ◽

Tufan Gümüş ◽

...

Keyword(s):

Peptic Ulcer ◽

Perforated Peptic Ulcer ◽

Patient Characteristics ◽

Comorbid Disease ◽

Duration Of Symptoms ◽

Mortality And Morbidity ◽

Ulcer Disease ◽

Asa Score ◽

Comorbid Diseases ◽

American Society

Regarding the complications of peptic ulcer, a perforation remains the most important fatal complication. The aim of our retrospective study was to determine relations between postoperative morbidity and comorbid disease or perioperative risk factors in perforated peptic ulcer. In total, 239 patients who underwent emergency surgery for perforated peptic ulcer in Ege University General Surgery Department, between June 1999 and May 2013 were included in this study. The clinical data concerning the patient characteristics, operative methods, and complications were collected retrospectively. One hundred seventy-five of the 239 patients were male (73.2%) and 64 were female (26.8%). Mean American Society of Anesthesiologists (ASA) score was 1 in the patients without morbidity, but mean ASA score was 3 in the morbidity and mortality groups. Primary suture and omentoplasty was the selected procedure in 228 of the patients. Eleven patients underwent resection. In total, 105 patients (43.9%) had comorbidities. Thirty-seven patients (67.3%) in the morbidity group had comorbid diseases. Thirteen (92.9%) patients in the mortality group had comorbid diseases. Perforation as a complication of peptic ulcer disease still remains among the frequent indications of urgent abdominal surgery. Among the analyzed parameters, age, ASA score, and having comorbid disease were found to have an effect on both mortality and morbidity. The controversial subject in the present study is regarding the duration of symptoms. The duration of symptoms had no effect on mortality nor morbidity in our study.

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Study of clinical and endoscopic profile of dyspepsia and upper gastrointestinal bleed

International Journal of Advances in Medicine ◽

10.18203/2349-3933.ijam20190114 ◽

2019 ◽

Vol 6 (1) ◽

pp. 106

Author(s):

Akash Rajender ◽

Priyanka Choudhary ◽

Saumya Mathur ◽

Rajat Bhargava ◽

Shalini Upadhyay ◽

...

Keyword(s):

Peptic Ulcer ◽

Malignant Lesion ◽

Gi Endoscopy ◽

Gastrointestinal Bleed ◽

Upper Gi ◽

Upper Gastrointestinal Bleed ◽

Upper Gi Endoscopy ◽

Gi Bleed ◽

Gandhi Medical College ◽

Upper Gastrointestinal

Background: Upper gastrointestinal bleed (UGIB) and dyspepsia are the commonest indications for an upper GI endoscopy (UGIE), which has the potential to provide both diagnostic and therapeutic intervention. Alarm symptoms in patients with dyspepsia need proper evaluation.Methods: In an observational hospital-based study, 5117 patient undergoing upper GI endoscopy were evaluated at Mahatma Gandhi Medical College and Hospital, Jaipur, Rajasthan, India. Detailed clinical and endoscopic profile was evaluated for subjects with dyspepsia and UGIB. Statistical analysis was done using SPSS version 21.0.Results: Dyspepsia (2887, 56.41%) followed by upper GI bleed (1124, 21.97%) were the most common indications for UGIE. In subjects presenting with UGIB, most patients had both hematemesis with Malena (48.04%), 48.93% were chronic alcoholics and nearly one fourth (26.96%) were on NSAIDS. Variceal bleeding (52.94%), followed by peptic ulcer bleed (13.43%) were the most common causes of bleed. In subjects undergoing UGIE for dyspepsia, 37.41% revealed no endoscopic lesion followed by gastro-duodenitis (25.01%). Peptic ulcer was cause of dyspepsia in 18.05% and was significantly more in those with alarm symptoms (<0.001). Alarm symptoms in dyspepsia has a significant high likelihood of finding a malignant lesion on endoscopic evaluation (p 0.013).Conclusions: Variceal bleed is the most common cause of UGIB in the adult Indian population. In patients with dyspepsia, presence of alarm symptoms is significantly associated with organic lesion on endoscopy. Although the incidence of malignancy is low, endoscopy in more than 50years subjects presenting with dyspepsia may help in early diagnosis and reducing morbidity.

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Spectrum of upper gastrointestinal bleed: An experience from Eastern India

Journal of Digestive Endoscopy ◽

10.4103/0976-5042.189146 ◽

2016 ◽

Vol 07 (02) ◽

pp. 055-061 ◽

Cited By ~ 2

Author(s):

Md Nadeem Parvez ◽

Mahesh Kumar Goenka ◽

Indrajeet Kumar Tiwari ◽

Usha Goenka

Keyword(s):

Peptic Ulcer ◽

Serum Creatinine ◽

Serum Albumin ◽

Elderly Age ◽

Ulcer Disease ◽

Gastrointestinal Bleed ◽

Upper Gastrointestinal Bleed ◽

Geographical Regions ◽

The Mean ◽

Upper Gastrointestinal

Abstract Background/Aims: The etiology of upper gastrointestinal bleed (UGIB) is variable in different geographical regions. Epidemiological data are helpful in knowing the burden of the problem. This study was conducted to know the etiological spectrum, mortality, morbidity, and predictors of outcome in patients with acute UGIB. Materials and Methods: We retrospectively analyzed the data of patients admitted to our hospital between January 2013 and May 2015, with UGIB and noted the clinical presentation, etiology of bleed, and outcome. Results: A total of 337 patients [272 (80.7%) male, 65 (19.3%) female (male:female ratio: 4:1)] of UGIB were included in the study. The mean age of the patients was 55.11 ± 14.8 years (Range - 14–85 years). The most common etiology of UGIB was peptic ulcer (40.05%) followed by varices (33%). Majority of patients were managed medically. Endotherapy was required only in 33% patients. The mean duration of hospital stay was 6.6 ± 5.79 days. Rebleed was seen in 11 (3.2) patients and surgery was required in 6 (1.7%). In hospital, mortality was 2.6%. Age ≥65 years (odds ratio [OR]: 9.5, 95% confidence interval [CI]: 3.108–29.266), serum albumin <3 g/dl (OR: 3.1, 95% CI: 1.049–9.682), and serum creatinine >2 mg/dl (OR: 4.1, 95% CI: 1.068–8.591) were associated with increased mortality. Conclusions: Peptic ulcer disease is still the most common cause of UGIB. Majority of patients can be managed medically. Rebleed rate, need for surgery, and mortality due to UGIB are declining. Elderly age (>65), hypoalbuminemia serum albumin<3g/dl (<3) and renal dysfunction (serum creatinine >2) are important factors associated with increased mortality.

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