PERFORATED PEPTIC 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.

Download Full-text

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.

Download Full-text

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.

Download Full-text

A Five-Year Review of Perforated Peptic Ulcer Disease in Irrua, Nigeria

International Scholarly Research Notices ◽

10.1155/2017/8375398 ◽

2017 ◽

Vol 2017 ◽

pp. 1-6 ◽

Cited By ~ 2

Author(s):

A. E. Dongo ◽

O. Uhunmwagho ◽

E. B. Kesieme ◽

S. U. Eluehike ◽

E. F. Alufohai

Keyword(s):

Peptic Ulcer ◽

Peptic Ulcer Disease ◽

Emergency Admission ◽

Perforated Peptic Ulcer ◽

Duodenal Perforation ◽

Peptic Ulcer Perforation ◽

Ulcer Disease ◽

A Prospective Study ◽

Age Range ◽

Structured Questionnaire

Background. Peptic ulcer perforation is a common cause of emergency admission and surgery. This is the first study that documents the presentation and outcome of management in Irrua, Nigeria. Patients and Method. This is a prospective study of all patients operated on for perforated peptic ulcer between April 1, 2010, and March 31, 2015. A structured questionnaire containing patients’ demographics, operation findings, and outcome was filled upon discharge or death. Results. There were 104 patients. 81 males and 23 females (M : F = 3.5 : 1). The age range was between 17 years and 95 years. The mean age was 48.99 years ± SD 16.1 years. The ratio of gastric to duodenal perforation was 1.88 : 1. Perforation was the first sign of peptic ulcer disease in 62 (59.6%). Pneumoperitoneum was detectable with plain radiographs in 95 (91%) patients. 72 (69.2%) had Graham’s Omentopexy. Death rate was 17.3%. Conclusion. We note that gastric perforation is a far commoner disease in our environment. Perforation is often the first sign of peptic ulcer disease. We identify fasting amongst Christians as a risk factor for perforation.

Download Full-text

Outcome of Non-operative Management of Perforated Peptic Ulcer Disease

Journal of Surgical Sciences ◽

10.3329/jss.v22i2.44072 ◽

2020 ◽

Vol 22 (2) ◽

pp. 95-98

Author(s):

Sanjana Sharmin Shashi ◽

AZM Shakhwat Hossain ◽

Debashish Bar ◽

Ayesha Rahman ◽

AFM Muntahi Reza ◽

...

Keyword(s):

Peptic Ulcer ◽

Peptic Ulcer Disease ◽

Operative Treatment ◽

Perforated Peptic Ulcer ◽

Operative Management ◽

Peptic Ulcer Perforation ◽

Ulcer Disease ◽

Medical College ◽

Institutional Ethics ◽

Non Operative Management

Background: Peptic ulcer perforation management is still an enigma. Though the overall incidence has been reduced worldwide due to wide use of anti-ulcerants, still it is not uncommon. But there is a debate regarding its conservative management over surgical management. Objective: To determine whether surgery could be avoided in selected patients with perforated peptic ulcer disease Methods: This study was conducted in the department of Surgery of Sir Salimullah Medical College and Mitford Hospital during the period from 1st March 2016 to 31st August 2016. After approval from the institutional ethics committee, 30 patients of suspected perforated peptic ulcer disease were successively assigned in this study on clinical and radiological basis. All were given non-operative regimen up to 24 hours. Then they were closely monitored to see improvement of clinical condition or development of any complication. Non-operative treatment was abandoned if the patient failed to improve or deteriorated within 24 hours of non-operative treatment. The data were collected by active participation of patients’ interview in preformed data collection sheet. Results: The data analysis of 30 patients yielded that most of them (86.67%) recovered well after receiving non-operative management, whereas only 4 patients (13.33%) showed no progression and were treated by laparotomy. 73.08% patients with uneventful outcome left the hospital within 10 days of admission and the others were a little late to leave. Conclusion: Patients with perforated peptic ulcer disease can be effectively treated by conservative approach in properly selected cases by proper monitoring under strict supervision of an experienced consultant. Journal of Surgical Sciences (2018) Vol. 22 (2) : 95-98

Download Full-text

Surgical treatment of perforated gastric ulcer

Medicinski pregled ◽

10.2298/mpns0212513k ◽

2002 ◽

Vol 55 (11-12) ◽

pp. 513-516 ◽

Cited By ~ 1

Author(s):

Milan Korica ◽

Goran Petakovic ◽

Sava Gavrilovic

Keyword(s):

Peptic Ulcer ◽

Gastric Ulcer ◽

Surgical Treatment ◽

Surgical Procedures ◽

Postoperative Mortality ◽

Perforated Peptic Ulcer ◽

Peptic Ulcer Perforation ◽

Simple Closure ◽

Ulcer Disease ◽

Ulcer Perforation

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.

Download Full-text

What are the benefits and harms of laparoscopic repair in people with perforated peptic ulcer disease?

Cochrane Clinical Answers ◽

10.1002/cca.398 ◽

2016 ◽

Author(s):

Kurinchi Gurusamy

Keyword(s):

Peptic Ulcer ◽

Peptic Ulcer Disease ◽

Laparoscopic Repair ◽

Perforated Peptic Ulcer ◽

Ulcer Disease

Download Full-text

FEASIBILITY OF ERAS (ENHANCED RECOVERY AFTER SURGERY) PROTOCOL IN PATIENTS UNDERGOING EMERGENCY REPAIR FOR PERFORATED PEPTIC ULCER DISEASE IN A TERTIARY CARE HOSPITAL

10.36106/ijsr/1219188 ◽

2021 ◽

pp. 41-43

Author(s):

Chayan Rui ◽

Chandan Roy Choudhury ◽

Puspak Ghosh

Keyword(s):

Peptic Ulcer ◽

Peptic Ulcer Disease ◽

Enhanced Recovery ◽

Enhanced Recovery After Surgery ◽

Tertiary Care ◽

Perforated Peptic Ulcer ◽

Patch Repair ◽

Care Hospital ◽

Ulcer Disease ◽

Emergency Repair

Introduction: The surgical treatment of perforated peptic ulcer disease has evolved in parallel to advances in medical treatment of Peptic Ulcer Disease. Objective: To investigate the feasibility of ERAS (Enhanced Recovery after Surgery) Pathways in patients undergoing emergency repair for Perforated peptic ulcer disease. Materials and methods: Institutional based prospective analytical study. Indoor patients in Dept. of General Surgery in Medical College and Hospital Kolkata. January 2019 to June 2020. Study was conducted for 18 months.14 months was provided for data collection. Next 2 months for statistical analysis and another 2 months for thesis writing and submission. Conclusion: ERAS pathway (with some modications) seems to be safe and feasible in a highly selected subset of patients undergoing emergency Omental grahams patch repair of Perforated Peptic Ulcer Disease

Download Full-text