Evaluation of Boey scoring in predicting morbidity and mortality in peptic ulcer 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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Spectrum of Perforation Peritonitis in a Rural Medical College

Bangladesh Journal of Medical Science ◽

10.3329/bjms.v15i1.20857 ◽

2016 ◽

Vol 15 (1) ◽

pp. 70-73 ◽

Cited By ~ 4

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

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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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Factors affecting morbidity and mortality in peptic ulcer perforation

International Surgery Journal ◽

10.18203/2349-2902.isj20181105 ◽

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.

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Use of Boey’s score in peptic perforation disease in the Nepalese population: a prospective observational study

Journal of Society of Surgeons of Nepal ◽

10.3126/jssn.v22i1.28708 ◽

2019 ◽

Vol 22 (1) ◽

pp. 2-6

Author(s):

Rabin Koirala ◽

Paras Pant ◽

Nikhil Acharya ◽

Asish Rajbhandary

Keyword(s):

Peptic Ulcer ◽

Observational Study ◽

Hospital Stay ◽

Prospective Observational Study ◽

Postoperative Mortality ◽

Length Of Hospital Stay ◽

Morbidity And Mortality ◽

Peptic Ulcer Perforation ◽

Mortality And Morbidity ◽

Ulcer Perforation

Introduction: Peptic ulcer perforation carries high mortality and morbidity. Boey’s score is shown to be a simple scoring system to help predict morbidity and mortality. This is a prospective observational study to evaluate the applicability of Boey’s score in predicting mortality and morbidity in Nepalese patients. Methods: This study was conducted in the Dept. of Surgery, Nepal Medical College and Teaching Hospital (NMCTH), Attarkhel, Jorpati between 1st of July 2012 to 30th June 2019 over a period of 7 years. This was a prospective observational study. All patients who underwent laparotomy for suspected peptic ulcer perforation peritonitis were included in the study. Results: Fourty-seven patients were included in the study. Male patients outnumbered females by a ratio of almost 4:1. Eighteen (38%) patients had Boey’s score of 1, and 7 (15 %) patients had a Boey’s score of 3. Overall postoperative mortality was 7 (15%). Boey’s score predicted morbidity and mortality with a p-value of <0.01. The length of hospital stay was also more in patients with a higher score and it was statistically significant. Conclusions: Boey’s score is both easy and effective in predicting postoperative morbidity, mortality and length of hospital stay.

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Feasibility of laparoscopic repair of peptic ulcer perforation

International Surgery Journal ◽

10.18203/2349-2902.isj20211821 ◽

2021 ◽

Vol 8 (5) ◽

pp. 1526

Author(s):

Sanjay Sisodiya ◽

Badri Prasad Patel

Keyword(s):

Peptic Ulcer ◽

Peptic Ulcer Disease ◽

Laparoscopic Repair ◽

Peptic Ulcer Perforation ◽

Concomitant Disease ◽

Wound Infections ◽

Ulcer Disease ◽

Ulcer Perforation ◽

Early Return ◽

Perforation Peritonitis

Background: Perforation is a common complication of peptic ulcer disease and presents as Perforation peritonitis. It has the highest number of mortality among all complications (≈15%). In spite of modern progress in the management, it is still a life-threatening catastrophe. Emergency surgery for complicated cases required in 7% of hospitalized peptic ulcer disease patients. Factors such as >24 hours of history, concomitant disease, shock, post operated wound infections, all are associated with increase in mortality and morbidity.Methods: A Prospective, observational, single hospital base study done during the period from 2016 to 2020 in the Department of Surgery, Gandhi medical college Bhopal. Sample size was taken 63Results: 52 out 63 cases presented with perforation peritonitis included under study period, 11 cases were excluded due to death and absconding of cases. In rest 52 cases, 15 of them went through laparoscopic repair, 28.85% of the cases were shifted directly to ORG.Conclusions: Laparoscopic repair of peptic ulcer perforation is feasible if patient presents early to the hospital. All perforation peritonitis should give fair chance to repair laparoscopically if patient’s general condition and anesthetic permits. This is a good alternative for conventional open surgery with less post-operative pain, early return to normal activities, less hospital stays and few postoperative wound infections. Thus it can significantly decrease the economic burden.

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Assessment of recent epidemiological trends in peptic ulcer perforation patients in an eastern indian tertiary hospital

Asian Journal of Medical Sciences ◽

10.3126/ajms.v9i6.20858 ◽

2018 ◽

Vol 9 (6) ◽

pp. 68-75

Author(s):

Bikash Chandra Ghosh ◽

Ambar Gangopadhyay ◽

Gautam Ghosh

Keyword(s):

Peptic Ulcer ◽

Urban Slum ◽

Morbidity And Mortality ◽

Patch Repair ◽

Peptic Ulcer Perforation ◽

Still Life ◽

Management Options ◽

Ulcer Perforation ◽

Sequence Of Events ◽

H Pylori

Background: Peptic Ulcer perforation is one of the most important and dreaded complication of peptic ulcer disease. In-spite of recent therapeutic management options available, it is still life threatening catastrophe. Sudden release of gastric and duodenal content in peritoneal cavity leads to devastating sequence of events which if not properly managed may lead to death. Age and Gender adjusted analysis of incidence, morbidity and mortality and the effect of ulcerogenic medications, addictions and H. Pylori infection in prognosis were studied here. Postoperative outcomes were also assessed after giving same type of treatments (Preoperative resuscitation, Graham’s Patch repair, and postoperative care) given by same surgical team.Aims and Objectives: The aims and objectives of this study were to investigate the latest trends of incidence, presentation, morbidity and mortality of benign perforated gastro-duodenal ulcer among the various age groups of population and to further study the risk factors associated with these events and study the association of addiction, ulcerogenic medications and H. Pylori infection.Materials and Methods: This observational descriptive study was conducted in R.G.Kar Medical College, Kolkata between the periods from January 2016 to June 2017 among 102 patients.Results: In this study of 102 patients 97% were male patients, maximum number of patient were from the age group 15 -30 years (45.1%).86.3% were from low socio- economic status and 40.2% residing in urban slum. Maximum number of patients presenting within 72 hrs (71%) having zero mortality. Seventy four percent of patients presented with shock if came between 4-5 days with 17.39% mortality. Patient presenting after 5 days had mortality of 75% and shock was 100% finding. Size <1 cm having 1% mortality but if size is >1 cm then mortality was >50.5%.Conclusion: Perforated peptic ulcer is common among males in second and third decade of their life with patients living in rural and urban slum commonly affected. Most common predisposing factors for PPU among younger population were addictions like smoking or alcohol intake. Among the elderly patients, intake of ulcerogenic medications like NSAID and steroids was the most common predisposing factor for PPU. Among patients of non-NSAID associated PPU, Helicobacter pylori infection was the major cause in the pathogenesis of PPU.Asian Journal of Medical Sciences Vol.9(6) 2018 68-75

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RISK FACTORS AFFECTING PEPTIC ULCER PERFORATION

10.36106/9500445 ◽

2021 ◽

pp. 11-14

Author(s):

Ketan Patel ◽

Harshit Agarwal ◽

Jitendra K. Mangtani ◽

Neelkamal Gupta

Keyword(s):

Risk Factors ◽

Risk Factor ◽

Peptic Ulcer ◽

Posterior Wall ◽

Peptic Ulcer Perforation ◽

Factors Affecting ◽

Ulcer Disease ◽

Ulcer Perforation ◽

Operative Outcome ◽

Perforation Peritonitis

Introduction: Peptic ulcer is a sore in the lining of stomach or the rst part of the duodenum. Peptic ulcer perforation with subsequent peritonitis is commonest complication of peptic ulcer disease and is a surgical emergency. It carries with it great morbidity and mortality. AIMS: To study the risk factors associated with peptic ulcer perforation in our setting. Objectives: To Assess the role of various risk factors like age, sex, previous use of NSAIDS, Smoking & other associated illness. To study the risk factors that affect operative outcome in peptic perforation peritonitis. Materials & Methods: All patients of peptic ulcer with perforation peritonitis on laparotomy are included in the study.Patients with peptic ulcer Perforation of age > 14 years. Results: Duodenal perforations were present In 69 cases out of 100 cases (69%). Gastric perforation was present in 31 cases (31%). In gastric cases 30 perforations were present on lesser curvature and pyloric Antrum and one perforation was present on posterior wall of stomach. Discussion: Present clinical study of peptic perforation has been carried out to nd out various risk factor associated with It's occurrence, investigation, clinical picture, preoperative ndings and post operative outcome and recurrence of perforation after taking Anti H. pylori regime was observed. Conclusion:In my study that H.pylori infection, smoking, use of NSAID's is signicant risk factor on peptic perforation

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