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 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 Factors affecting morbidity and mortality in peptic ulcer perforation

2018 ◽  
Vol 5 (4) ◽  
pp. 1335
Author(s):  
Kadasiddeshwara G. Byakodi ◽  
Harini B. S. ◽  
Vasant Teggimani ◽  
Narayan Kabade ◽  
Abhijit Hiregoudar ◽  
...  
Keyword(s):  
Peptic Ulcer ◽  
Peptic Ulcer Disease ◽  
Female Gender ◽  
Morbidity And Mortality ◽  
P Value ◽  
High Morbidity ◽  
Peptic Ulcer Perforation ◽  
Female Population ◽  
Ulcer Disease ◽  
Ulcer Perforation

Background: Peptic ulcer disease is very common disease in developing countries and so are its complications. With the introduction of H2 receptor antagonists and proton pump inhibitors, the incidence of elective surgery for peptic ulcer (PU) disease has decreased dramatically, although complications of peptic ulcer disease such as perforation and bleeding have remained fairly constant.Methods: A prospective study was conducted on43 patients presenting to KIMS Hospital, Hubli with features suggestive of hollow viscus perforation and intraoperative findings suggestive of peptic ulcer perforation from January 2015 to June 2016.Results: In this study, there were 43 cases of peptic ulcer perforation. Peptic ulcer perforation was common in third decade of life(n=12) with the mean age(SD) 39.88 years. Perforation is more common in males as compared to the female population 7.6:1. Post-operative morbidity is seen in 31 (72.1%) of patients and mortality in 4 (9.3%). Smoking, Alcohol beverage consumption, regular ingestion of NSAIDs were commonly seen in patients with peptic ulcer perforation but these factors were not significant risk factors for postoperative mortality and morbidity. Age ≥60 years (p-value 0.051), Female gender (p-value 0.012), Presence of co-morbid conditions (p-value 0.055), Shock on admission (p-value 0.029, perforation-surgery interval >24 hours (p-value 0.001), preoperative higher-grade ASA, purulent intraperitoneal collection (p-value 0.002) were statistically significant predictors of mortality.Conclusions: Perforated peptic ulcer (PPU) is a life-threatening disease with historically reported high morbidity and mortality rates. Age ≥60 years, female gender, presence of co-morbidities, preoperative shock, higher ASA grade, perforation-surgery interval >24 hours, Purulent intraperitoneal collection are inter-related statistically significant predictors of mortality. Therefore, proper resuscitation from shock, improving ASA grade and decreasing delay in surgery is needed to improve overall results.

POMPP Score: Evaluation of Mortality and Morbidity in Patients with Secondary Peritonitis

2018 ◽  
Vol 3 (04) ◽  
Author(s):  
Shergill J. S. ◽  
Sharma S. ◽  
Kaur R. ◽  
Sunkaria B. L
Keyword(s):  
Peptic Ulcer ◽  
Perforated Peptic Ulcer ◽  
Exploratory Laparotomy ◽  
Gastrointestinal Perforation ◽  
Predictive Score ◽  
Peptic Ulcer Perforation ◽  
Mortality And Morbidity ◽  
Ulcer Perforation ◽  
Tract Perforation ◽  
Time Of Admission

Background: Gastrointestinal tract perforation is one of the common surgical emergency all over the world. Menekse et al devised POMPP score (predictive score of mortality in perforated peptic ulcer) to predict the morbidity and mortality in peptic ulcer perforation. Aim: The objective of this study was to assess the validity of POMPP score in peptic ulcer perforation and to assess its usefulness in gastrointestinal perforation due to causes other than the peptic ulcer. Methods: Fifty consecutive cases, who had undergone exploratory laparotomy for gastrointestinal perforation peritonitis, were included in the study. “These patients were assessed at the time of admission on the basis of Age >65 years, BUN >45mg/dl (Blood Urea Nitrogen) and Albumin <1.5g/L and a score of 1 point each had been given”. The total score was compared with the outcome of the disease in relation with mortality. Results: In our study, 42% of gastrointestinal perforation were due to peptic ulcer, 22 % due to small bowel perforations (18% Ileal and 4 % Jejunal), 14 % due to trauma and 22 % due to miscellaneous causes. Morbidity is common after gastrointestinal perforation and it ranges from 17-63% whereas mortality ranges from 6-14%. Conclusions: POMPP score is easy and valid scoring system for peptic ulcer perforation. Early detection of high risk peptic perforation cases, allow other supportive treatment modality apart from surgery which can decrease the mortality. However, this score is not valid in perforation due to causes other than peptic ulcer.

Clinical Presentation and Management of Patients with Peptic Ulcer Perforation in Kashmir - A Prospective Study

2021 ◽  
Vol 8 (27) ◽  
pp. 2368-2372
Author(s):  
Abdul Rashid Ganaie ◽  
Zuneera Banoo ◽  
Aamir Hussain Hela ◽  
Ishfaq Ahmad Hakeem ◽  
Haseeb Mohammad Khandwaw
Keyword(s):  
Peptic Ulcer ◽  
Clinical Presentation ◽  
Perforated Peptic Ulcer ◽  
Patch Repair ◽  
Medical Illness ◽  
Peptic Ulcer Perforation ◽  
Female Ratio ◽  
Ulcer Perforation ◽  
Plain Chest Radiograph ◽  
Number Of Patients

BACKGROUND Around 4 million people are affected by peptic ulcer diseases worldwide annually. The incidence of around 1.5 % to 3 % has been estimated. Peptic ulcer perforation presents with an overall mortality of 10 %. The management is also associated with significant post-operative morbidity and mortality regardless of whether laparoscopic or open repair is performed. In this study, we wanted to find out the incidence of peptic ulcer perforation and its management. METHODS Our study was a prospective observational study conducted in post graduate Department of Surgery, Government Medical College Srinagar, from October 2018 to November 2020. All patients were evaluated properly with all baseline investigations followed by X-ray chest and abdomen and ultrasonography (USG). RESULTS In our study, 136 patients were diagnosed as cases of peptic ulcer perforation. The maximum number of patients were in age group of 41 - 50 years (27.20 %). The male : female ratio was 14.1 : 1. Abdominal pain was present in all patients as presenting symptom followed by abdominal distension. In this study, 124 patients (91.2 %) had perforation in first part of duodenum, 9 patients (6.6 %) had perforation in prepyloric region and 3 (2.2 %) patients had perforation in body of stomach. Graham’s Patch repair was done in 133 patients, 1 patient underwent primary closure, and 2 patients underwent distal gastrectomy with gastrojejunostomy. CONCLUSIONS Our study shows that young people with perforated peptic ulcer have fewer coexisting medical illness, a lower complication rate and a more favorable outcome as compared to elderly patients with perforated peptic ulcer. A majority of such perforations are in 1st part of duodenum with male preponderance. A plain chest radiograph is sufficient to make diagnosis in the classic case of sudden onset epigastric pain. KEYWORDS Perforation Peritonitis, Management of Peptic Ulcer Perforation, Graham’s Repair, Clinical Presentation of Peptic Ulcer Perforation

scholarly journals Evaluation of mortality and morbidity in patients with secondary peritonitis using predictive score of mortality in perforated peptic ulcer

2017 ◽  
Vol 4 (8) ◽  
pp. 2706
Author(s):  
Navin Kumar ◽  
Shantanu Kumar Sahu ◽  
Karamjot Singh Bedi
Keyword(s):  
Peptic Ulcer ◽  
Perforated Peptic Ulcer ◽  
Exploratory Laparotomy ◽  
Gastrointestinal Perforation ◽  
Predictive Score ◽  
Peptic Ulcer Perforation ◽  
Mortality And Morbidity ◽  
Ulcer Perforation ◽  
Tract Perforation ◽  
Time Of Admission

Background: Gastrointestinal tract perforation is one of the common surgical emergency all over the world. Menekse et al devised POMPP score (predictive score of mortality in perforated peptic ulcer) to predict the morbidity and mortality in peptic ulcer perforation. The objective of this study was to assess the validity of POMPP score in peptic ulcer perforation and to assess its usefulness in gastrointestinal perforation due to causes other than the peptic ulcer.Methods: Fifty consecutive cases, who had undergone exploratory laparotomy for gastrointestinal perforation peritonitis, were included in the study. “These patients were assessed at the time of admission on the basis of Age >65 years, BUN >45mg/dl (Blood Urea Nitrogen) and Albumin <1.5g/L and a score of 1 point each had been given”. The total score was compared with the outcome of the disease in relation with mortality.Results: In our study, 42% of gastrointestinal perforation were due to peptic ulcer, 22 % due to small bowel perforations (18% Ileal and 4 % Jejunal), 14 % due to trauma and 22 % due to miscellaneous causes. Morbidity is common after gastrointestinal perforation and it ranges from 17-63% whereas mortality ranges from 6-14%.Conclusions: POMPP score is easy and valid scoring system for peptic ulcer perforation. Early detection of high risk peptic perforation cases, allow other supportive treatment modality apart from surgery which can decrease the mortality. However, this score is not valid in perforation due to causes other than peptic ulcer.

scholarly journals Spectrum of Perforation Peritonitis in a Rural Medical College

2016 ◽  
Vol 15 (1) ◽  
pp. 70-73 ◽  
Author(s):  
Mohinder Kumar Malhotra ◽  
Rikki Singal ◽  
Kunal Chowdhary ◽  
Ram Gopal Sharma ◽  
Saurabh Sharma ◽  
...  
Keyword(s):  
Peptic Ulcer ◽  
Medical Science ◽  
Major Complication ◽  
Morbidity And Mortality ◽  
Gallbladder Perforation ◽  
High Morbidity ◽  
Peptic Ulcer Perforation ◽  
Ulcer Perforation ◽  
Perforation Peritonitis ◽  
Operative Findings

Aim: Perforation peritonitis is the most common surgical emergency encountered by surgeons in India. The etiology and sites of perforation shows wide geographical variation. The objective of the study was to find the spectrum of perforation peritonitis & highlight its management at Maharishi Markendeshwar Institute of Medical Sciences & Research, Mullana (MMIMSR).Methods: 93 Operated patients of perforation peritonitis were studied retrospectively in terms of clinical presentation, duration, operative findings and postoperative morbidity and mortality over a period of two years between 2011 to 2013 at MMIMSR Mullana. All the patients had undergone emergency laparatomy under general anesthesia and sites of perforation were identified & managed.Results: The most common cause of perforation peritonititis noticed in our series was peptic ulcer perforation 43 cases (46%), followed by ileal perforation 30 cases (32%), appendicular perforation 6 cases (6.4%), gallbladder perforation 5 cases (5.3%) and all the jejunal perforation 6cases (6.4%) was post traumatic. Large bowel and malignant perforation were least common in our series. Highest no. of perforation noticed in upper part of Gastro intestinal tract as compared to western countries where perforations are seen in distal parts. Mortality was of 11 cases (11.8%) & morbidity was noticed in 55 cases (59%).Conclusion: Peptic ulcer perforation peritonitis is the leading etiology. Mortality is comparable to that of best centre. Aggressive resuscitation and early minimum surgery are required to avoid the high morbidity and mortality. Major complication noticed was wound infection and dehiscence.Bangladesh Journal of Medical Science Vol.15(1) 2016 p.70-73

scholarly journals Association of Helicobacter Pylori with Peptic Ulcer Perforation

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.

scholarly journals Comparative study between POMPP score versus Boey score to predict morbidity and mortality in peptic perforation peritonitis

2021 ◽  
Vol 8 (2) ◽  
pp. 543
Author(s):  
Bhanu Prakash K. R. ◽  
Subhas Patil ◽  
Manasa Mohan
Keyword(s):  
Peptic Ulcer ◽  
Morbidity And Mortality ◽  
High Rate ◽  
P Value ◽  
Peptic Ulcer Perforation ◽  
Hollow Viscus ◽  
Mortality And Morbidity ◽  
Ulcer Disease ◽  
Ulcer Perforation ◽  
Perforation Peritonitis

Background: Peptic ulcer disease (PUD) results from an imbalance between stomach acid-pepsin and mucosal defense barriers. It affects 4 million people worldwide annually. Peptic ulcer perforation is one of the most common surgical emergencies and is associated with a high rate of morbidity and mortality. This is due to presence of various risk factors among the population like H. pylori infection, long term NSAID use, alcohol ingestion, smoking and steroid use. Peptic ulcer perforation peritonitis usually requires an emergency surgical intervention and hence the need for this study, to compare POMPP and Boey scores as predictors of morbidity and mortality in patients with peptic perforation peritonitis.Methods: This prospective observational study was conducted in the hospitals attached to Bangalore Medical College and Research Institute from November 2018 to May 2020. All patients above 18 years with features of hollow viscus perforation with per-operative finding of perforated peptic ulcer were included in the study. Patients with histopathology suggestive of malignancy were excluded.Results: A total of 65 patients were included in the study. On analysis of the data by Chi-square test, P value of both POMPP and Boey scores was found to be <0.05 which is statistically significant. The most important predictive factors of mortality and morbidity were duration of perforation >24 hours, age >65 years and pre-operative shock.Conclusions: Both scoring systems are easy to use and can assist in accurate and early identification of high-risk patients and are important in predicting mortality and morbidity in patients with peptic ulcer perforation.

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