Surgical treatment of perforated gastric ulcer

Introduction Peptic ulcer perforation is a complication of ulcer disease which requires urgent surgical treatment. The aim of this paper was to point out our experience in surgical treatment of perforated peptic ulcer. Material and methods This retrospective study analyzes results of surgical treatment in 365 patients with perforated peptic ulcer during the period January 1996 to December 2000. Results During the last 5-year period 365 patients were treated following peptic ulcer perforation. The average age was 43.53?8.26, with the span from 18 to 86. The most frequent surgical procedures in treatment of peptic ulcer perforation were: simple closure with biopsy (55.88%), excision of the ulcer with a pyloroplasty and vagotomy (35.29%) as nonresection surgical procedures and stomach resection after Billroth II (8.83%). The postoperative mortality was 4.41%. Conclusions The methods of choice in surgical treatment of gastric ulcer perforation are nonresection surgical procedures with drug therapy and eradication of Helicobacter pylori, if present.

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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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Correlation Between Candidiasis And Mortality In Gastric Ulcer Perforation Patients

BioScientia Medicina ◽

10.32539/bsm.v5i4.370 ◽

2021 ◽

Vol 5 (4) ◽

pp. 947-952

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

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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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PERFORATED PEPTIC ULCER DISEASE;

The Professional Medical Journal ◽

10.29309/tpmj/2019.26.04.3378 ◽

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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Prevalence of Helicobacter pylori in peptic ulcer perforation

International Surgery Journal ◽

10.18203/2349-2902.isj20174494 ◽

2017 ◽

Vol 4 (10) ◽

pp. 3350 ◽

Cited By ~ 2

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.

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A CROSS-SECTIONAL STUDY TO PREVALENCE OF HELICOBACTER PYLORI IN PEPTIC ULCER PERFORATION AT DMCH, LAHERIASARAI, BIHAR

10.36106/6432013 ◽

2021 ◽

pp. 4-5

Author(s):

Ravindra Ravindra ◽

Vijay Shankar Prasad ◽

Debarshi Jana

Keyword(s):

Helicobacter Pylori ◽

Peptic Ulcer ◽

Perforated Peptic Ulcer ◽

Cross Sectional Study ◽

Peptic Ulcer Perforation ◽

Sectional Study ◽

Cross Sectional ◽

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 Upgraded Department of Surgery, Darbhanga Medical College & Hospital, Laheriasarai, Bihar. 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. pylori infection was conrmed 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 signicant 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 signicant 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 signicant. 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.

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Laparoscopic Repair of Peptic Ulcer Perforation - Our Initial Experience

Journal of Paediatric Surgeons of Bangladesh ◽

10.3329/jpsb.v1i2.19535 ◽

2014 ◽

Vol 1 (2) ◽

pp. 153-157

Author(s):

Md. Saiful Hoque ◽

Gazi Mohammad Zakir Hossain ◽

Nur Hossain Bhuiyan ◽

Md. Rashedul Hasan ◽

Mayin Uddin Mahmud ◽

...

Keyword(s):

Peptic Ulcer ◽

Gastric Ulcer ◽

Laparoscopic Repair ◽

Operation Time ◽

Perforated Peptic Ulcer ◽

Peptic Ulcer Perforation ◽

Related Complication ◽

Ulcer Perforation ◽

Delayed Recovery ◽

Duodenal Ulcer Perforation

Background: Laparoscopic repair of perforated peptic ulcer was reported in 1990 but has not gained wide acceptance. The aim of this study was to evaluate the safety and efficacy of laparoscopic repair in routine clinical practice.Methods: This was a prospective analysis of 30 patients who underwent laparoscopic repair of a perforated peptic ulcer between July 2009 and June2010.Results: Thirty patients of mean age 45 (range 25-52) years had perforated ulcer diagnosed by clinical examination and x-ray abdomen and confirmed by laparoscopy. 28 was duodenal ulcer perforation and rest 2 was gastric ulcer perforation. Only 3 patients required conversion to laparotomy out of them 2 were DU perforation and one was gastric ulcer perforation. Mean operation time was 75 (range 75-150) minutes. Mean postoperative hospital stay was 6 (5-10) days. Postoperative convalescences were good. There was no operation related complication but one patient needs transfer to ICU for delayed recovery and the patient eventually recovered well. Post-operative leakage occurred in one patient and that was treated by laparotomy. One of 3 conversion cases developed wound infection but wound related complications in laparoscopic cases were very negligibe.Conclusion: Laparoscopic repair is a safe and effective procedure for repair of perforated peptic ulcer.DOI: http://dx.doi.org/10.3329/jpsb.v1i2.19535

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

International Surgery Journal ◽

10.18203/2349-2902.isj20210054 ◽

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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