DUODENAL ULCER PERFPRATION - A CLINICAL STUDY IN A TERTIARY HEALTH CARE SET UP.

BACKGROUND - Peptic ulcer disease though having multifactorial etiologies, out of which H.pyroli infection and NSAIDs use are leading causes of duodenal perforation. Gastro-duodenal perforations are common in surgical practice. Acute perforations of duodenum are estimated to occur in 2-10% of patients with ulcers. MATERIALS AND METHODS - This a retrospective study ( done between August 2019 to August 2020), where 100 patients with duodenal ulcer perforation were enrolled, analyzed and compared in Department of General Surgery, Veer Surendra Sai Institute of Medical Science And Research (VIMSAR) , Burla, Sambalpur. RESULTS – More common in 40-59 years age group, male and lower socioeconomic status. CONCLUSION-Duodenal ulcer perforation is one of the most common acute abdominal emergencies.

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Clinical Study on Patients with Duodenal Perforation

Academia Journal of Surgery ◽

10.47008/ajs/2020.3.1.15 ◽

2020 ◽

Vol 3 (1) ◽

pp. 71-74

Author(s):

S P Rajan ◽

Sudheer UK ◽

Sreejith ◽

Dinesh Babu M V

Keyword(s):

Duodenal Ulcer ◽

Peptic Ulcer ◽

Clinical Study ◽

Wound Complication ◽

Duodenal Perforation ◽

X Ray ◽

Male Predominance ◽

Ulcer Perforation ◽

Duodenal Perforations ◽

Duodenal Ulcer Perforation

Background: Perforations of peptic ulcer are third in frequencies, acute appendicitis and acute intestinal obstruction being more common. Prompt recognition of the condition is very important and only by early diagnosis and treatment it is possible to reduce the still relatively high mortality. The aim of this study was to review and study the factors influencing, the outcome of the duodenal perforations. Subjects and Methods: A clinical study was conducted in 50 cases of diagnosed duodenal ulcer perforation that was established by the admitting surgeon, based on clinical features and supposed by radiological evidence and confined at operation. This study comprises of 50 cases of duodenal ulcer perforation admitted in period from January 2017 to January 2020. Results: In present study, out of total 50 patients with duodenal ulcer 46(92%) males and 5(8%) females, with male predominance. Highest incidence was found between 41-50 years followed by 21-29 years. Most of the patients admitted by 12-24 hours, common site of ulcer is prepyloric in presentation. Duodenal ulcer perforations were single perforation, while two cases of ileal perforations were multiple. Smoking is main predisposing cause of ulcer. ARDS were 14% (7 patients) and it was observed that 32 percent (16 patients) having wound complication, 2 percent (‘1 patient) having mortality and 46% (23 patients) have no complications. In this present study, 60% of patients had h/o Peptic ulcer. On X- ray, 90% of patients had finding of air under diaphragm. Conclusion: The mortality in perforated duodenal ulcer has been reduced owing to early approach to hospital, diagnosis, prompt surgical treatment and appropriate and adequate antibiotics. Smoking and alcohol consumption and life style modification may reduce morbidity and mortality in patients with duodenal perforation.

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A randomized comparative study between omentopexy and omental plugging in treatment of duodenal perforation

International Surgery Journal ◽

10.18203/2349-2902.isj20194421 ◽

2019 ◽

Vol 6 (10) ◽

pp. 3662

Author(s):

Debashis Mondal ◽

Avijeet Mukherjee

Keyword(s):

Duodenal Ulcer ◽

Standard Deviation ◽

Wound Infection ◽

Tissue Loss ◽

Surrounding Tissue ◽

Duodenal Perforation ◽

Ulcer Perforation ◽

Bacterial Peritonitis ◽

Duodenal Perforations ◽

Duodenal Ulcer Perforation

Background: Perforation due to duodenal ulcer is a common cause of peritonitis and is considered as one of the most catastrophic complication of duodenal ulcer perforation. Repair of perforation are considered particularly hazardous because of the extensive duodenal tissue loss, friability of the ulcer margins, surrounding tissue inflammation, poor general condition of the patient and overwhelming sepsis due to bacterial peritonitis. Thus, there is a need to compare closure of duodenal perforations by either Graham’s patch (OX) or omental plugging (OP) which are the simpler and more common methods followed these days in duodenal perforation management.Methods: The clinical material consists of all inpatients admitted under General Surgery for management of duodenal ulcer perforation at College of Medicine and JNM Hospital, Nadia. The study was conducted during the period from July 2018 to June 2019. This study consisted of 50 consecutive cases and diagnosis was made on the basis of clinical and histopathological findings.Results: A total of 73 patients were enrolled for the study. All our patients were males. Wound infection (OX -21.1%, OP -14.3%), septicaemia (OX-15.8%, OP-11.4%), and lung complication (OX-13.2%, OP-11.4%) were the commonest complications. Mean postoperative stay for OX was 12.92 with standard deviation 3.00 while in OP was 11.54 with standard deviation 1.54 (statistically significant).Conclusions:OP is associated with less incidence of postoperative complication in compared to omentopexy procedure for example wound infection, reperforation, lung complication, septicemia and intra-abdominal abscess. OP is associated with less number of mortality. OP is associated with higher mean operative time as it is a relatively newer and less utilized technique.

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Study of factors affecting mortality and morbidity in patients presenting with peritonitis due to duodenal ulcer perforation

Medpusle International Journal of Surgery ◽

10.26611/1061921 ◽

2021 ◽

Vol 19 (2) ◽

pp. 35-39

Author(s):

Pradeep Chandra Sharma ◽

Keyword(s):

Duodenal Ulcer ◽

Previous History ◽

Common Factors ◽

Duodenal Perforation ◽

High Morbidity ◽

Delayed Presentation ◽

Mortality And Morbidity ◽

Factors Affecting ◽

Ulcer Perforation ◽

Duodenal Ulcer Perforation

Background: Peptic ulcer disease in the general population had lifetime prevalence of 5-10% with incidence of 0.1–0.3% per year. Despite the tremendous improvement in preventive therapies, the rate of complication of this disease is still high and is burdened by high morbidity and mortality. In present study, we aimed to study factors affecting mortality and morbidity in patients presenting with peritonitis due to duodenal ulcer perforation at our tertiary hospital. Material and Methods: Present study was single-center, prospective, observational study conducted in patients admitted, diagnosed with duodenal ulcer perforation and surgically treated at our hospital. Results: In present study period total 56 patients were studied. All were male, most common age group was 51-60 years (37.5%) followed by 41-50 years (23.21%). Duration from onset of symptoms to admission was >24 hours (30.36%) in most of patients followed by 12-24 hours (28.57%). Most commons symptoms were pain in abdomen (100%), vomiting (100%). Anaemia (37.5%), LRTI and Pulmonary complications (19.64%), Diabetes mellitus (12.5%) and Hypertension (10.71%) were common comorbidities noted. Associated risk factors were previous history of PUD (41.07%), Alcohol use (64.29%), Cigarette smoking (51.79%) and Use of NSAIDs (12.5%). Presence of free gas under diaphragm was noted in 83.93% patients. Intraoperatively duodenal perforation diameter was 1–5 mm (60.71%) in most of patients followed by 6–10 mm (23.21%). Only 1 patient had duodenal perforation diameter was > 20mm. Common postoperative complications were wound infection (37.5%) and pulmonary infection (21.43%). In present study mortality within 1 month was noted in 13 patients (23.21%). Most common factors related to mortality were delayed presentation > 24 hours (61.54%), age > 60 years (46.15%), diabetes mellites (38.46%), Size of perforation > 1 cm (38.46%) and septicaemic shock (23.08%). Conclusion: Delayed presentation > 24 hours, age > 60 years size of perforation > 1 cm were common factors related to mortality in duodenal ulcer perforation patients.

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A Novel Approach to Managing Giant Duodenal Ulcer Perforations: Minimizing Ostomies, Maximizing Decompression. A Case Report

Surgical Case Reports ◽

10.31487/j.scr.2019.05.114 ◽

2019 ◽

pp. 1-3

Author(s):

Daniel Gross ◽

Egelko Aron ◽

Levi Amelia ◽

Roudnitsky Valery

Keyword(s):

Duodenal Ulcer ◽

Feeding Tube ◽

Peptic Ulcer Perforation ◽

Duodenal Ulcers ◽

Ulcer Perforation ◽

Novel Approach ◽

Giant Duodenal Ulcer ◽

Novel Method ◽

Duodenal Perforations ◽

Duodenal Ulcer Perforation

Background: Peptic ulcer perforation is a deadly complication of duodenal ulcers. The literature is still sparse in terms of giant duodenal perforations. There exist a variety of techniques to decompress the duodenum after repair which leave the patient with multiple ostomies that require extensive postoperative care. Case presentation: In this case we present a patient with AIDS who was found to have a large duodenal ulcer perforation. Intraoperatively the fragility of the patient’s duodenum warranted a method of decompression that would keep the integrity of the duodenal tissue. The common method of lateral duodenostomy was not the best option and instead a gastro-jejunal feeding tube was altered into a gastro-duodenal tube to avoid creating another ostomy. Postoperatively she did not show signs of leak, but eventually died from sepsis secondary to fulminant AIDS. Conclusions: We propose this technique as a novel method of decompressing the duodenum. This new method eliminates the need for excessive ostomies and has the possibility to make the postoperative transition simpler.

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A RARE CASE OF VALENTINO SYNDROME- CASE REPORT

International Journal of Medical and Biomedical Studies ◽

10.32553/ijmbs.v5i11.2301 ◽

2021 ◽

Vol 5 (11) ◽

Author(s):

Rohit K Phadnis ◽

Suditi Sharma ◽

Sai Lavanya Patnala ◽

Faiz Hussain ◽

Neha Chigulapalli

Keyword(s):

Duodenal Ulcer ◽

Case Report ◽

Acute Appendicitis ◽

Diagnostic Laparoscopy ◽

Iliac Fossa ◽

Rare Condition ◽

Duodenal Perforation ◽

Ulcer Perforation ◽

The Right ◽

Duodenal Ulcer Perforation

Background: Valentino’s syndrome refers to acute abdomen with clinical presentation mimicking acute appendicitis in a Perforated gastric or duodenal ulcer. This occurs when suppurative fluid from duodenal perforation trickles down the paracolic gutter to the right iliac fossa causing peritonitis locally and causes periappendicitis. Less than 50 cases have been reported in literature of the same. Case report and discussion: A 42-year-old male was admitted to the general surgery department with pain in the right iliac fossa and epigastric region. A diagnostic laparoscopy was performed under the suspicion of Acute appendicitis, which was later converted to open laparotomy on finding a perforated duodenal ulcer. Review of Literature: Valentino syndrome is a rare condition in which a duodenal ulcer mimics acute appendicitis which is a diagnosed intraoperatively and managed surgically. Although the exact incidence is unknown, less than 50 cases have been reported worldwide. The first incidence reports back to 1926 when an Italian actor, Rodolfo Valentino who succumbed to this rare disease and it was named after him. Conclusion: Differential diagnosis of duodenal ulcer perforation should be considered for adult patient with diagnosis of acute appendicitis. X ray erect abdomen and diagnostic laparoscopy can help to overcome foot in mouth situation due to missed duodenal ulcer perforation. Keywords: Valentino syndrome.

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A clinical study of factors affecting the prognosis in duodenal ulcer perforation cases in tertiary care hospital, Kanchipuram district

International Surgery Journal ◽

10.18203/2349-2902.isj20195214 ◽

2019 ◽

Vol 6 (12) ◽

pp. 4290

Author(s):

Dhinesh Babu K. ◽

M. Bhaskar

Keyword(s):

Duodenal Ulcer ◽

Peptic Ulcer ◽

Tertiary Care ◽

Peptic Ulcer Perforation ◽

Care Hospital ◽

Chronic Alcoholic ◽

Factors Affecting ◽

Ulcer Disease ◽

Ulcer Perforation ◽

Duodenal Ulcer Perforation

Background: Peptic ulcer disease is an erosion of the lining of the stomach or duodenum. It is associated with potentially life-threatening complications such as bleeding, perforation and obstruction. The main predisposing factors for peptic ulcer perforation are smoking, use of non-steroidal anti-inflammatory drugs (NSAIDs), chronic stress, Helicobacter pylori infection, and age >60 years. In recent years, with introduction of proton pump inhibitors and increased knowledge of duodenal ulcer perforation (DUP) has decreased the incidence of DUP.Methods: 50 patients with DUP were studied prospectively with respect to age, gender, use of NSAIDs, morbidity, mortality and complications.Results: Out of 50 patients, the mean age of incidence DUP was 46 yrs, which is more common in males. And also 48% patients were chronic alcoholic and 52% patients were chronic smokers. Moreover, 14% patients were chronic NSAIDs users.Conclusions: Factors such as age, gender, use of NSAID, Alcohol and smoking affects the life expectancy of the patients, which leads to morbidity and mortality.

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Laparoscopic cloasure of Duodenal ulcer perforation

Journal of Society of Surgeons of Nepal ◽

10.3126/jssn.v18i3.15271 ◽

2016 ◽

Vol 18 (3) ◽

pp. 16

Author(s):

Anang Pangeni ◽

Vikal Chandra Shakya

Keyword(s):

Duodenal Ulcer ◽

Young Patients ◽

Laparoscopic Approach ◽

Duodenal Perforation ◽

Invasive Approach ◽

Ulcer Perforation ◽

Perforation Peritonitis ◽

The Mean ◽

A Prospective Study ◽

Duodenal Ulcer Perforation

Introduction and Objective: Duodenal ulcer perforation creates a peritonitis which is sometimes hard to manage, especially with minimally invasive approach. This study is about laparoscopic approach to peritonitis due to duodenal ulcer perforation.Materials and Methods: It was a prospective study in patients presenting with duodenal perforation peritonitis to emergency of Civil Service Hospital from January 2013 to November 2015.Result: There were 6 patients (4 males and 2 females). The mean duration of presentation was 16+2.32 hrs. The mean operative time was 55+17.34 minutes. One patient developed right lower zone pneumonia which resolved on conservative management. There was no conversion.Conclusion: Laparoscopic management of duodenal perforation is a feasible procedure in select young patients who present early and without any without comorbities

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