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 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 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.

A HOSPITAL BASED STUDY OF INCIDENCE OF PEPTIC ULCER PERFORATION IN YOUNG ADULTS

2021 ◽  
pp. 25-27
Author(s):  
Ganesh Chandra Karan ◽  
Mridul Rai ◽  
Debarshi Jana
Keyword(s):  
Peptic Ulcer ◽  
Positive Family History ◽  
Perforated Peptic Ulcer ◽  
World Population ◽  
Ulcer Formation ◽  
Peptic Ulcer Perforation ◽  
Female Ratio ◽  
Mortality And Morbidity ◽  
Ulcer Perforation ◽  
Associated Risk Factors

Background: Peptic ulcer formation affects about 2-10% of world population every year with higher incidence in younger individuals. Being a surgical emergency, it has higher mortality and morbidity. Thus, the aim of our study was to evaluate the incidence of peptic ulcer perforation based on gender, age and also to study its associated risk factors, clinical presentations, site along with surgical management and complications. Materials & Methods: 75 patients diagnosed with perforated peptic ulcer were included and this study was conducted in the Upgraded Department of Surgery, Darbhanga Medical College and Hospital, Laheriasarai, Bihar. Structured performa was prepared to obtained details of patients. Results: 76% of patients in our study were males and 24% were females with male and female ratio 1:3.16. The prevalence of perforation was high in age group 20-30 years (30.7%). 62.7% of cases had positive family history and the incidence was in the patients who consumed non-vegetarian (84.8%), spicy (61.4%) and oily (69.5%) foods. Frequently observed clinical presentation were abdominal pain followed by tenderness and rigidity and gas under diaphragm. The common site of perforation was duodenum (62.7%) and most of the cases were treated by closure with omental patch (81.3%). The post-surgical complications frequently observed were wound infection (30.6%) and chest infection (28%). Conclusion: Peptic ulcer perforation is common disorder of gastrointestinal tract, now affecting younger adults with male preponderance. It is associated with unwanted health and economic issues. Therefore, earlier management is only the way to minimize complications and mortality

scholarly journals Prevalence of Helicobacter pylori in peptic ulcer perforation

2017 ◽  
Vol 4 (10) ◽  
pp. 3350 ◽  
Author(s):  
Binni John ◽  
Bipin P. Mathew ◽  
Vipin Chandran C.
Keyword(s):  
Helicobacter Pylori ◽  
Peptic Ulcer ◽  
Peptic Ulcer Disease ◽  
Eradication Therapy ◽  
Perforated Peptic Ulcer ◽  
Peptic Ulcer Perforation ◽  
Female Ratio ◽  
Ulcer Disease ◽  
Ulcer Perforation ◽  
H Pylori

Background: Helicobacter pylori have an important role in the pathogenesis of peptic ulcer disease. The aim of the present study was to observe the prevalence of H. pylori in peptic ulcer perforation cases and the rationale of H. pylori eradication therapy post operatively and to investigate factors associated with peptic ulcer.Methods: This cross-sectional study was conducted at the Department of general surgery, Government Medical College, Kottayam for a period 20 months from March 2012 to October 2013 after getting approval from institutional ethics committee. A total of 113 patients were participated in the study after meeting inclusion criteria. After getting written consent from the patients with perforated peptic ulcer, resuscitation and laparotomy was performed in the emergency department. H. pyloriinfection was confirmed by histopathological examination by Giemsa staining. Based on the histopathological report, the prevalence of H. pylori infection in the patients was assessed and was given appropriate H. pylori eradication regimen.Results: The mean age of presentation of the patients was 52.81±14.5 years. Male to female ratio was 4.14:1. Out of 113 cases, 67 cases (59.3%) had duodenal ulcer perforation while 46 cases (40.7%) had gastric ulcer perforation. Of them 53(46.9%) cases were positive H. pylori positive. No significant association was found between the incidence of H. pylori infection in peptic ulcers with smoking, hypertension, diet intake, NSAIDS intake. In our study association between H. pylori and diabetes mellitus (p=0.02) found to be significant which can be further investigated.Conclusion: According to our study the prevalence of H. pylori infection in perforated peptic ulcer disease is 47% which must be considered as significant. Hence all the patients undergoing laparotomy for peptic ulcer perforation should be investigated for H. pylori infection and if positive we must start the anti H. pylori regimen for them, which is more cost effective.

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

2019 ◽  
Vol 2 (1) ◽  
pp. 11
Author(s):  
Inge Kurniawati ◽  
I Ketut Wiargitha ◽  
Tjokorda Gde Bagus Mahadewa ◽  
Bianca Jeanne
Keyword(s):  
Peptic Ulcer ◽  
High Risk ◽  
Risk Stratification ◽  
Perforated Peptic Ulcer ◽  
The Elderly ◽  
Peptic Ulcer Perforation ◽  
Diagnostic Validity ◽  
Emergency Unit ◽  
Ulcer Perforation ◽  
Risk Patients

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.  

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

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.

scholarly journals PERFORATED PEPTIC ULCER

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.

scholarly journals PERFORATED PEPTIC ULCER DISEASE;

2019 ◽  
Vol 26 (04) ◽  
Author(s):  
Abdul Hakeem Jamali ◽  
Altaf Hussain Ghumro ◽  
Inayat Ali Zardari ◽  
Mashooq Ali Khwaja ◽  
Zulfiqar Imtiaz Memon ◽  
...  
Keyword(s):  
Peptic Ulcer ◽  
Peptic Ulcer Disease ◽  
Surgical Procedures ◽  
Gastric Perforation ◽  
Perforated Peptic Ulcer ◽  
Health Science ◽  
Peptic Ulcer Perforation ◽  
Female Ratio ◽  
X Ray ◽  
Ulcer Disease

Introduction: Peptic ulcer perforation is the most common surgical emergency and the leading cause of peritonitis with high morbidity and mortality in all age groups throughout world. It is more prevalent in developing countries than developed ones. Graham’s Patch/omentopexy for duodenal perforation and simple closure along with tissue biopsy for the gastric perforation are the procedures of choice respectively. Objectives: To detect the mode of presentation and the outcomes of surgical procedures along with prognosis in patients suffering from perforated peptic ulcer. Study Design: Cross sectional study. Place and Duration of Study: Surgical Department of Peoples University of Medical & Health Science for Women Nawabshah, From January 2016 to December 2017. Methodology: All patients were admitted through OPD/Emergency. Patients presented with peritonitis having history of peptic ulcer disease were studied. X Ray chest/ X Ray abdomen Erect showed pnemoperitonium. Laparotomy and primary repair along with biopsy for gastric perforation and graham’s patch for duodenal perforations were performed. Results: In our study, total 52 patients were included. Male Female ratio was 3.5:1.6. Mean age was 49 years. Majority of patients presented in 5th to 6th decade of their life. In 96% cases abdominal pain was the 1st symptom followed by vomiting and distension of abdomen. Different surgical procedures were performed and surgical site infection was the commonest complication in 37 (73%) patients in our study. Conclusion: Primary closure and graham’s patch are the best choice as surgical procedures for the cases of gastric and duodenal ulcer perforations respectively.

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