scholarly journals Spontaneous esophageal rupture following perforated peptic ulcer: a report of two cases

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Chieh-Wei Chang ◽  
Yu-Ju Hung ◽  
Chien-Pin Chan ◽  
Chang-Lun Huang
Keyword(s):  
Peptic Ulcer ◽  
Minimally Invasive ◽  
Primary Repair ◽  
Correct Diagnosis ◽  
Oral Intake ◽  
Perforated Peptic Ulcer ◽  
High Morbidity ◽  
Esophageal Rupture ◽  
Case Presentation ◽  
Spontaneous Esophageal Rupture

Abstract Background Spontaneous esophageal rupture, also called Boerhaave’s syndrome, is relatively uncommon but may result in high morbidity and mortality. Synchronous presentation of spontaneous esophageal rupture and perforated peptic ulcer was rare and may contribute to the difficulty of achieving a correct diagnosis. Case presentation We reported two patients with spontaneous esophageal rupture following perforated peptic ulcer. Both patients were successfully treated with thoracoscopic primary repair of esophageal rupture. The first patient underwent peptic ulcer repair via laparotomy. The second patient underwent laparoscopic duodenorrhaphy. Both patients resumed oral intake smoothly and were discharged uneventfully. Conclusion Minimally invasive approaches are safe and feasible for both esophageal rupture and perforated peptic ulcer in patients diagnosed within 24 h and without shock.

Transabdominal Approach for Management of Boerhaave's Syndrome

2007 ◽  
Vol 73 (5) ◽  
pp. 511-513
Author(s):  
Aamir Z. Khan ◽  
Mathew J. Forshaw ◽  
Andrew R. Davies ◽  
Taryn Youngstein ◽  
Robert C. Mason ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Intensive Care Unit Stay ◽  
Best Practice ◽  
Oral Intake ◽  
Esophageal Rupture ◽  
Boerhaave’S Syndrome ◽  
Transabdominal Approach ◽  
Spontaneous Esophageal Rupture ◽  
Boerhaave's Syndrome

Several transthoracic approaches have been described for the surgical management of Boerhaave's syndrome that carry their own morbidity in patients who can be systemically unwell at presentation, and best practice is not established. We introduce a novel transabdominal approach to manage the perforation and spare these patients the trauma of a thoracotomy. Four patients with spontaneous esophageal rupture were managed using a transabdominal approach. Postoperative complications, length of intensive care unit stay, postoperative hospital stay, time to oral intake, and morbidity and mortality were used as outcome measures. After operation, the median intensive care unit stay was 4 days (range, 0–5) in patients who required a median of 10.5 days (range, 6–17) to establish oral intake. One patient required a transthoracic drainage of an empyema and one patient required percutaneous drainage of a mediastinal collection. The median length of stay was 38 days and there was zero mortality. The transabdominal approach is safe and effective for the management of Boerhaave's syndrome and should be considered in the treatment paradigm for this condition. Intrathoracic complications account for postoperative morbidity.

scholarly journals Laparoscopic Repair for Perforated Duodenal Ulcer

2015 ◽  
Vol 20 (3) ◽  
pp. 168-172
Author(s):  
Cotirleţ A. ◽  
Tincu E. ◽  
Coşa Raluca ◽  
Popa E. ◽  
Gavril Laura ◽  
...  
Keyword(s):  
Peptic Ulcer ◽  
Laparoscopic Repair ◽  
Perforated Peptic Ulcer ◽  
Gastric Surgery ◽  
High Morbidity ◽  
Ulcer Disease ◽  
Surgical Emergencies ◽  
Abdominal Disease ◽  
Laparoscopic Closure ◽  
Prolonged Surgery

Abstract Perforated peptic ulcer (PPU), despite antiulcer medication and Helicobacter eradication, is still the most common indication for emergency gastric surgery associated with high morbidity and mortality. Perforated peptic ulcer is a common abdominal disease that is treated by surgery. The development of laparoscopic surgery has changed the way to treat such abdominal surgical emergencies but there is no consensus on whether the benefits of laparoscopic closure of perforated peptic ulcer outweigh the disadvantages such as prolonged surgery time and greater expense. However we can say that laparoscopic repair is a viable and safe surgical option for patients with perforated peptic ulcer disease and should be considered with the necessary expertise available.

scholarly journals CLINICAL STUDY AND MANAGEMENT OF PERITONITIS SECONDARY TO PERFORATED PEPTIC ULCER

2020 ◽  
pp. 1-4
Author(s):  
Sanjay Kumar Suman ◽  
Mukesh Kumar ◽  
Pawan Kumar Jha ◽  
Debarshi Jana
Keyword(s):  
Peptic Ulcer ◽  
Clinical Presentation ◽  
Clinical Signs ◽  
Perforated Peptic Ulcer ◽  
Morbidity And Mortality ◽  
Duodenal Perforation ◽  
High Morbidity ◽  
Peptic Ulcer Perforation ◽  
Common Cause ◽  
Ulcer Perforation

Background: Perforated peptic ulcer is the most common cause among all causes of gastrointestinal tract perforationwhich is an emergency condition of the abdomen that requires early recognition and timely surgical management. Peptic ulcer perforation is associated significant morbidity and mortality. The aim of study is to evaluate the incidence, clinical presentation, management and outcomes of the patient with peptic ulcer perforation undergoing emergency laparotomy. Methods: This retrospective study includes 45 patients who were operated for perforated peptic ulcer peritonitis atDepartment of Surgery, Indira Gandhi Institute of Medical Sciences, Patna, Bihar from October 2018 to March 2020. Paediatricpatients of age less than 14 years, patients presenting as recurrent perforation were excluded from the study. A detailed history, clinical presentation and routine investigations were done in all cases. Results: In the present study, most of the patients were male. Most of these patients presents with clinical signs ofperitonitis between 24-48 hours after onset of the pain. Among the patients of peptic ulcer perforation, duodenal perforation (93.3%) is more common and which is the most common cause of perforation peritonitis. The diagnosis is made clinically and confirmed by presence of gas under diaphragm on radiograph. Exploratory laparotomy with simple closure of perforation with omental patch was done in all cases. The most common post-operative complication was wound infection (57.5%). The overall mortality was 11.1%. Conclusions: Late presentation of peptic ulcer perforation is common with high morbidity and mortality. Surgicalintervention with Graham’s omentopexy with broad spectrum antibiotics is still commonly practiced.

scholarly journals Clinical study and management of peritonitis secondary to perforated peptic ulcer

2017 ◽  
Vol 4 (8) ◽  
pp. 2721
Author(s):  
Dushyant Kumar Rohit ◽  
R. S. Verma ◽  
Grishmraj Pandey
Keyword(s):  
Peptic Ulcer ◽  
Clinical Presentation ◽  
Clinical Signs ◽  
Perforated Peptic Ulcer ◽  
Morbidity And Mortality ◽  
High Morbidity ◽  
Peptic Ulcer Perforation ◽  
Common Cause ◽  
Ulcer Perforation ◽  
Tract Perforation

Background: Perforated peptic ulcer is the most common cause among all causes of gastrointestinal tract perforation which is an emergency condition of the abdomen that requires early recognition and timely surgical management. Peptic ulcer perforation is associated significant morbidity and mortality. The aim of study is to evaluate the incidence, clinical presentation, management and outcomes of the patient with peptic ulcer perforation undergoing emergency laparotomy.Methods: This retrospective study includes 45 patients who were operated for perforated peptic ulcer peritonitis at Bundelkhand Medical College and Associated Hospital, Sagar from March 2015 to April 2017. Paediatric patients of age less than 14 years, patients presenting as recurrent perforation were excluded from the study. A detailed history, clinical presentation and routine investigations were done in all cases.Results: In the present study, most of the patients were male. Most of these patients presents with clinical signs of peritonitis between 24-48 hours after onset of the pain. Among the patients of peptic ulcer perforation, duodenal perforation (93.3%) is more common and which is the most common cause of perforation peritonitis. The diagnosis is made clinically and confirmed by presence of gas under diaphragm on radiograph. Exploratory laparotomy with simple closure of perforation with omental patch was done in all cases. The most common post-operative complication was wound infection (57.5%). The overall mortality was 11.1%.Conclusions: Late presentation of peptic ulcer perforation is common with high morbidity and mortality. Surgical intervention with Graham’s omentopexy with broad spectrum antibiotics is still commonly practiced.

scholarly journals Role of primary repair in spontaneous esophageal rupture management: decades of experience from a single center

2020 ◽  
Vol 133 (23) ◽  
pp. 2885-2886
Author(s):  
Bao-Zhong Li ◽  
Xin-Jian Xu ◽  
Hui Zhu ◽  
Xin Chen ◽  
Ming He
Keyword(s):  
Primary Repair ◽  
Esophageal Rupture ◽  
Single Center ◽  
Spontaneous Esophageal Rupture

scholarly journals Clinical Characteristics of Primary Repair for Perforated Peptic Ulcer: 10-Year Experience in a Single Center

2021 ◽  
Vol 10 (8) ◽  
pp. 1790
Author(s):  
Yun-Suk Choi ◽  
Yoon-Seok Heo ◽  
Jin-Wook Yi
Keyword(s):  
Liver Cirrhosis ◽  
Peptic Ulcer ◽  
Surgical Complications ◽  
Clinical Characteristics ◽  
Primary Repair ◽  
Perioperative Complications ◽  
Perforated Peptic Ulcer ◽  
Underlying Disease ◽  
Duodenal Perforation ◽  
Predisposing Factor

Background: Perforated peptic ulcer (PPU) is a disease whose incidence is decreasing. However, PPU still requires emergency surgery. The aim of this study was to review the clinical characteristics of patients who received primary repair for PPU and identify the predisposing factors associated with severe complications. Method: From January 2011 to December 2020, a total of 75 patients underwent primary repair for PPU in our hospital. We reviewed the patients’ data, including general characteristics and perioperative complications. Surgical complications were evaluated using the Clavien-Dindo Classification (CDC) system, with which we classified patients into the mild complication (CDC 0–III, n = 61) and severe complication (CDC IV–V, n = 14) groups. Result: Fifty patients had gastric perforation, and twenty-five patients had duodenal perforation. Among surgical complications, leakage or fistula were the most common (5/75, 6.7%), followed by wound problems (4/75, 5.3%). Of the medical complications, infection (9/75, 12%) and pulmonary disorder (7/75, 9.3%) were common. Eight patients died within thirty days after surgery (8/75, 10.7%). Liver cirrhosis was the most significant predisposing factor for severe complications (HR = 44.392, p = 0.003). Conclusion: PPU is still a surgically important disease that has significant mortality, above 10%. Liver cirrhosis is the most important underlying disease associated with severe complications.

scholarly journals Surgery for Perforated Peptic Ulcer: Is Laparoscopy a New Paradigm?

2021 ◽  
Vol 2021 ◽  
pp. 1-6
Author(s):  
André Pereira ◽  
Hugo Santos Sousa ◽  
Diana Gonçalves ◽  
Eduardo Lima da Costa ◽  
André Costa Pinho ◽  
...  
Keyword(s):  
Peptic Ulcer ◽  
Hospital Stay ◽  
Laparoscopic Repair ◽  
Laparoscopic Approach ◽  
Oral Intake ◽  
Length Of Hospital Stay ◽  
Perforated Peptic Ulcer ◽  
Open Group ◽  
New Paradigm ◽  
Female Ratio

Introduction. Laparoscopic repair of perforated peptic ulcer (PPU) remains controversial mainly due to its safety and applicability in critically ill patients. The aim of this study is to compare the outcomes of laparoscopy versus laparotomy in the treatment of PPU. Methods. Single-institutional, retrospective study of all patients submitted to surgical repair of PPU between 2012 and 2019. Results. During the study period, 169 patients underwent emergent surgery for PPU. A laparoscopic approach was tried in 60 patients and completely performed in 49 of them (conversion rate 18.3%). The open group was composed of 120 patients (included 11 conversions). Comparing the laparoscopic with the open group, there were significant differences in gender (male/female ratio 7.2/1 versus 2.2/1, respectively; p = 0.009 ) and in the presence of sepsis criteria (12.2% versus 38.3%, respectively; p = 0.001 ), while the Boey score showed no differences between the two groups. The operative time was longer in the laparoscopic group (median 100’ versus 80’, p = 0.01 ). Laparoscopy was associated with few early postoperative complications (18.4% versus 41.7%, p = 0.004 ), mortality (2.0% versus 14.2%; p = 0.02 ), shorter hospital stay (median 6 versus 7 days, p = 0.001 ), and earlier oral intake (median 3 versus 4 days, p = 0.021 ). Conclusion. Laparoscopic repair of PPU may be considered the procedure of choice in patients without sepsis criteria if expertise and resources are available. This kind of approach is associated with a shorter length of hospital stay and earlier oral intake. In patients with sepsis criteria, more data are required to access the safety of laparoscopy in the treatment of PPU.

scholarly journals Complicated Ventral Hernia: A Perquisite for Perforated Peptic Ulcer—Unusual Clinical Scenario

2021 ◽  
Vol 07 (02) ◽  
pp. e66-e68
Author(s):  
Jignesh A. Gandhi ◽  
Pravin Shinde ◽  
Bhavika Kothari ◽  
Marina Kharkongor
Keyword(s):  
Peptic Ulcer ◽  
Ventral Hernia ◽  
Rare Case ◽  
Surgical Intervention ◽  
Fluid Collection ◽  
Perforated Peptic Ulcer ◽  
Epigastric Hernia ◽  
Case Presentation ◽  
Perforated Gastric Ulcer ◽  
The Right

Abstract Introduction Peptic ulcer usually presents to the emergency in the form of an acute abdomen, which is usually diagnosed easily either clinically or radiologically. Although its incidence has decreased with the introduction on proton pump inhibitors it is still one of the most common emergencies encountered by a surgeon. Case Presentation A 60-year-old woman complained of epigastric swelling for 6 months which gradually increased and became irreducible over the last 2 months. The patient also complained of pain associated with vomiting. Radiological investigations revealed a epigastric hernia with omentum and stomach as content along with fluid collection in the right perihepatic region, with tiny air foci. The patient was explored for the same. Discussion Perforated peptic ulcer is a serious complication and carries high risk of morbidity and mortality. Early diagnosis with immediate resuscitation and surgical intervention is essential to improve outcomes. This is a rare case of perforated gastric ulcer which was masked under the complicated ventral hernia.

258 MANAGEMENT OF OESOPHAGO-GASTRIC LEAKS FOLLOWING MINIMALLY INVASIVE IVOR LEWIS OESOPHAGO-GASTRECTOMY USING DOUBLE PIGTAIL STENTS

2021 ◽  
Vol 34 (Supplement_1) ◽  
Author(s):  
Jeremy Tan ◽  
Wai Keong Wong ◽  
Baldwin Yeung ◽  
Bin Chet Toh ◽  
Lester Ong ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Oral Intake ◽  
Major Complication ◽  
Stent Migration ◽  
High Morbidity ◽  
Contrast Study ◽  
Anastomotic Leaks ◽  
Contrast Extravasation ◽  
Ivor Lewis ◽  
Pigtail Stent

Abstract   Anastomotic leak following Ivor Lewis oesophago-gastrectomy is a major complication with high morbidity and mortality. We report our experience with three such cases where endoscopically deployed double pigtail stents (DPT) were used to help manage the leaks. Methods Three patients from October 1, 2019 to February 29, 2020 experienced leakage from the oesophago-gastric anastomosis following minimally invasive Ivor Lewis oesophago-gastrectomy. These occurred on post-operative day 9, day 29 and day 7 respectively. All cases were managed with endoscopic deployment of double pigtail stents along with other adjunctive measures. Results To date all patients remain alive, with sepsis under control. One of the patients had been able to have his double pigtail stent removed at six weeks and he has been able to commence adjuvant chemotherapy. Another patient had a follow-up contrast study one week after DPT insertion which showed no further contrast extravasation and was able to recommence oral intake. The third patient has a left empyema (managed conservatively with a combination of internal DPT and external pigtail drainage) which is gradually resolving. Conclusion Endoscopically deployed DPTs are a useful tool in the armamentarium for managing oesophago-gastric anastomotic leaks in selected patients following Ivor Lewis oesophago-gastrectomy. They are advantageous in that stent migration does not appear to be an issue, nor is there any problem with leakage around the stent. Patients are mostly able to restart oral intake soon after insertion of DPTs. This reduces the morbidity associated with these anastomotic leaks, and reduces the number of interventions needed.

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