Diagnostic validity of PULP (peptic ulcer perforation) score in predicting mortality in patient with operated perforated peptic ulcer in Sanglah Hospital- Denpasar

Background: Perforated peptic ulcer (PPU) is one of the most common non-traumatic emergency cases in the emergency unit, and have a high mortality rate, more than 70% in the elderly. Accurate and early identification of high-risk surgical patients with PPU is important for triage and risk stratification. The objective of this study was to evaluate the mortality in patients with operated PPU.Methods: Between January 2015 to December 2016, 50 consecutive patients with PPU who performed laparotomy were studied retrospectively. This study was a diagnostic test to evaluate the validity of PULP (Peptic Ulcer Perforation) score to predict mortality in patient with operated PPU and determine the best cut-off point. Presentation ≥ or < 24 hours, age of 65 years old, the presence of preoperative shock, ASA score, the presence of AIDS or active malignancy, liver failure, concomitant use of steroids and serum creatinine > 14.7 g/dL were evaluated in PULP score.Results: The cut-off point for PULP the score in the present study is > 7, based on the optimal cut-off value, patients could be divided into low-risk patients (a score of < 7 points), and high-risk patients (a score of > 7 points). PULP score had 91.7% sensitivity, 65.4% specificity, and 78% accuracy in this study. Positive predictive value and negative predictive the values were 71% and 89.9%.Conclusion: The PULP score is sensitive to predict the mortality risk in patients operated for perforated peptic ulcer and can assist in risk stratification and triage.

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Risk Stratification in Perforated Peptic Ulcer: The Peptic Ulcer Perforation Score

SBV Journal of Basic, Clinical and Applied Health Science ◽

10.5005/jp-journals-10082-02220 ◽

2019 ◽

Vol 2 (3) ◽

pp. 112-114

Author(s):

Naren KA Kumar ◽

Stanley James

Keyword(s):

Peptic Ulcer ◽

Risk Stratification ◽

Perforated Peptic Ulcer ◽

Peptic Ulcer Perforation ◽

Ulcer Perforation

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A COMPARATIVE OBSERVATIONAL STUDY OF PROGNOSTIC FACTOR SCORES TO PREDICT MORBIDITY AND MORTALITY IN PATIENTS OF PERFORATED PEPTIC ULCER

10.36106/ijsr/0100270 ◽

2021 ◽

pp. 4-8

Author(s):

Ananay Vishvakarma ◽

Subhasish Roychowdhury ◽

Anil Kumar Saha

Keyword(s):

Peptic Ulcer ◽

High Risk ◽

Prognostic Factor ◽

Sofa Score ◽

Adverse Outcome ◽

Perforated Peptic Ulcer ◽

Morbidity And Mortality ◽

Factor Scores ◽

Increased Risk ◽

Risk Patients

Background: Perforation is one of the common complication of peptic ulcer disease which is associated with signicant morbidity and mortality. It is a disease which needs emergent surgical intervention. Accurate and early identication of high-risk patients with Perforated Peptic Ulcer is important for risk stratication. Here, we calculate the three prognostic factor scores, (i) The Boey Score, (ii) The Peptic ulcer perforation (PULP) score, and (iii) The quick sequential organ failure assessment (q-SOFA) score, preoperatively to predict postoperative outcome. Aims & Objective: The aim of the study is to identify patients with an increased risk of adverse outcome, so that we can target the level of perioperative monitoring and treatment in high-risk patients. Also, to determine and compare the ability of three prognostic factor scores to predict morbidity and mortality in patients of Perforated Peptic Ulcer. Methods: Aprospective comparative observational study was conducted comprising of 92 patients with conrmed perforated peptic ulcer (PPU) attending the emergency ward of Department of General Surgery between February 2019 to July 2020. After conrmation of diagnosis, risk stratication according to the three prognostic factor scores (Boey score, PULP score, and q-SOFA score) was done. Acomparison was made between each score through calculation of positive predictive value (PPV) and negative predictive value (NPV). We used receiver operating characteristics (ROC) curve in my study to estimate the predictive ability of each scoring system. Results: The study include 92 patients. Female 41.3% and Male 58.7%. The mean age was 45.38 years. The most common site of PPU was the rst part of duodenum - D1 (64.1%). The most common operative procedure done was the Grahm's patch repair. The morbidity rate was 28.3%. Overall mortality rate was 10.9%. The AUROC for morbidity prediction was 0.791 for Boey score, 0.918 for PULP score, and 0.61 for q-SOFAscore. The AUROC for mortality prediction was 0.829 for Boey score, 0.865 for PULPscore, and 0.602 for q-SOFAscore. Conclusion:Boey score and PULP score helps in accurate and early identication of PPU patients with an increased risk of adverse outcome. q-SOFA score cannot signicantly predict morbidity and mortality in PPU patients. Overall, PULP score performs best but Boey score is crude and simple to calculate and is used to assess the patient rapidly

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Association of Helicobacter Pylori with Peptic Ulcer Perforation

Journal of BP Koirala Institute of Health Sciences ◽

10.3126/jbpkihs.v2i1.24960 ◽

2019 ◽

Vol 2 (1) ◽

pp. 4-10

Author(s):

Sunit Agrawal ◽

D Thakur ◽

P Kafle ◽

A Koirala ◽

R K Sanjana ◽

...

Keyword(s):

Risk Factors ◽

Helicobacter Pylori ◽

Peptic Ulcer ◽

Peptic Ulcer Disease ◽

Perforated Peptic Ulcer ◽

Patch Repair ◽

Peptic Ulcer Perforation ◽

Ulcer Disease ◽

Ulcer Perforation ◽

H Pylori

Background: Helicobacter pylori is found in more than 90% cases of peptic ulcer. This study examines the possibility of association of Helicobacter pylori in perforated peptic ulcer disease and its relation to persisting ulcer as well as the influence of other risk factors; namely: smoking, alcohol, current non-steroidal anti inflammatory drugs (NSAIDs) and steroid use. Materials and Methods: In this prospective study, total of 50 cases of peptic ulcer perforation admitted in College of Medical Sciences and Teaching Hospital, Bharatpur, Nepal were selected on the basis of the non-probability (purposive) sampling method. All patients who presented with suspected peptic ulcer perforation were included in the study and the perforations were repaired by Modified Graham’s Patch and were given triple therapy postoperatively. The age, sex, incidence, mode of presentation, precipitating factors, association with the risk factors and postoperative complications were all evaluated and compared. Results: Of 50 patients studied, the age ranged from 17 to 75 years, mean age being 40.1 years with the peak incidence in the 3rd and 5th decades of life showing a male dominance (92%). H. pylori was seen in ulcer edge biopsy in 29 patients (58%). Most common clinical presentation was pain abdomen, the most common signs of perforation were tenderness, rebound tenderness and absent bowel sounds. The mean duration of stay in hospital in H. pylori positive patients was 12.07±8.15 days as compared with 11.1±5.12 days in H. pylori negative patients. The incidence of peptic ulcer perforation was higher in the patients consuming alcohol (64%) than smokers (48%), followed by NSAIDs user(22%). 20% of the patients with delayed presentation developed complications postoperatively. Perforated peptic ulcer was repaired by Modified Graham’s Patch Repair, followed by anti H. pylori therapy in all of them. Conclusion: Peptic ulcer perforation is quite common among the patients with peptic ulcer disease with history of chronic smoking, alcoholism and analgesic intake, more commonly in males. There is association of H. pylori in 58% of patients with peptic ulcer perforation.

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Peptic ulcer perforation: Management of high-risk cases by percutaneous abdominal drainage

Tropical Doctor ◽

10.1258/0049475053001822 ◽

2005 ◽

Vol 35 (1) ◽

pp. 30-31 ◽

Cited By ~ 3

Author(s):

M Mizanur Rahman ◽

A Al Mamun ◽

M Delwar Hossain ◽

M Kante Das

Keyword(s):

Peptic Ulcer ◽

High Risk ◽

Peptic Ulcer Perforation ◽

Abdominal Drainage ◽

Ulcer Perforation

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CLINICAL STUDY AND MANAGEMENT OF PERITONITIS SECONDARY TO PERFORATED PEPTIC ULCER

10.36106/ijsr/4127161 ◽

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.

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Clinical study and management of peritonitis secondary to perforated peptic ulcer

International Surgery Journal ◽

10.18203/2349-2902.isj20173209 ◽

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.

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RETROSPECTIVE STUDY OF PERFORATED PEPTIC ULCER: A TERTIARY HOSPITAL BASED STUDY

10.36106/ijar/6400560 ◽

2020 ◽

pp. 1-3

Author(s):

Omprakash Raj ◽

Sumit Dhruve

Keyword(s):

Peptic Ulcer ◽

Retrospective Study ◽

Standard Procedure ◽

Common Factor ◽

Perforated Peptic Ulcer ◽

Duodenal Perforation ◽

Peptic Ulcer Perforation ◽

Peptic Ulcers ◽

Case File ◽

Ulcer Perforation

Background: Peptic Ulcer Perforation is an important and common emergency. One of the most dreaded and common complication of peptic ulcers is perforation. Perforations account for about 5% of peptic ulcers. Aim and Objectives: The aim of this study is clinical study of perforated peptic ulcer with objectives to assess the socio demographic distribution of peptic ulcer and to assess the clinical presentations and management of peptic ulcer perforation. Methodology: This was a retrospective study conducted in Chhattisgarh Institute of Medical Sciences Bilaspur in year 2018-2019. Total 158 patients were taken, who were diagnosed and operated for perforated peptic ulcer. Detail history and clinical findings were taken from case file. Result: a total 158 patients were studied, 76% were male, and 41-50 years age group was commonly affected. Alcohol consumption, old age, comorbid illness and pre admission delayed was most common factor. Abdominal pain i.e. 100% was most common presentation. Duodenal perforation was common i.e.38.60%. omentopaxy was preferable mode of repair perforation. Conclusion: Perforation of peptic ulcer is one of the common surgical emergencies and requires awareness and prompt management and operation. It mostly affects young and middle aged males in the thirties. Simple closure with omentopaxy is standard procedure.

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PERFORATED PEPTIC ULCER

The Professional Medical Journal ◽

10.29309/tpmj/2011.18.01.1878 ◽

2011 ◽

Vol 18 (01) ◽

pp. 124-127

Author(s):

SIKANDER HAYAT KHAN ◽

MIRZA INAM UL HAQ ◽

SHAHZAD AKHTAR AZIZ

Keyword(s):

Peptic Ulcer ◽

Past History ◽

Armed Forces ◽

Perforated Peptic Ulcer ◽

Radiological Examination ◽

Duodenal Perforation ◽

Peptic Ulcer Perforation ◽

Ulcer Perforation ◽

Operative Complications ◽

Post Operative Complications

Objectives: To evaluate the epidemiology of peptic ulcer perforation in Armed Forces and further management / outcome of the patients. Methods: Data of 36 patients with perforated peptic ulcer collected. This data was analyzed on SPSS 13. Period and Setting: CMH Rawalpindi from Jan 1979 to July 1981, Jan 1985 to Dec 1987 and Jan 2001 to Dec 2003. Results: Out of 36 patients 35 were male and only one was female. Twenty four (67%) were between 31-50 years. No past history was taken from eight (22%) patients. Thirty four (94%) patients presented with duodenal perforation. Twenty patients (55%) had rigidity all over abdomen and peristalsis were present in ten (28%) patients who reported within twelve hours. Seventy eight (78%) were diagnosed by history and simple radiological examination. All the patients were treated by laparotomy (simple closure with omental patch). Post operative complications occur in ten (28%) patients and mortality rate was 8%. Conclusion: Predominantly the peptic ulcer perforation occurs between 30-50 years of age. The incidence reduces with succeeding years of study. Post operative complications were less in younger age group .Early diagnosis can be made easily by taking good history and performing simple radiological examination.

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Correlation Between Candidiasis And Mortality In Gastric Ulcer Perforation Patients

BioScientia Medicina ◽

10.32539/bsm.v5i11.370 ◽

2021 ◽

Vol 5 (11) ◽

pp. 1037-1041

Author(s):

Faradina Sulistiyani ◽

Vicky Sumarki Budipramana ◽

Pepy Dwi Endraswari

Keyword(s):

Peptic Ulcer ◽

Gastric Ulcer ◽

General Hospital ◽

Gastrointestinal Disease ◽

Perforated Peptic Ulcer ◽

Cross Sectional Study ◽

Peptic Ulcer Perforation ◽

Cross Sectional ◽

Ulcer Disease ◽

Ulcer Perforation

Background: Gastric ulcer disease remains the most common gastrointestinal disease. This affects about 4 million people every year worldwide with an incidence of 1.5%-3% and 2-14% of these will progress to perforation. Mortality is reported in 30% of cases and caused morbidity in 50% of patients. Some studies have suggested that mortality in patients with peritonitis accompanied by candidiasis ranges from 20%-75%, whereas others have argued that the presence of fungal isolates in patients with perforated peptic ulcer does not affect the outcome. A recent study reported an incidence of 45% of patients peptic ulcer perforation cases accompanied by candidiasis in Dr. Soetomo General Hospital Surabaya in 2019.Methods: This was a cross sectional study based on medical record data of patients with gastric ulcer perforation accompanied by candidiasis who underwent laparotomy and gastric repair surgery at Dr. Soetomo General Hospital Surabaya from January 2019 to December 2020.Results: There was no significant correlation between candidiasis and mortality in gastric ulcer perforation patients (p=0.989).Conclusion: Candidiasis does not increase mortality in patients with gastric ulcer perforation.

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