scholarly journals Treatment of duodenal peptic ulcer perforation by endoscopic clips: A novel approach

2017 ◽  
Vol 08 (01) ◽  
pp. 24-26 ◽  
Author(s):  
Mohan Achyut Joshi ◽  
Minakshi Gadhire ◽  
Ashwini Arun Paranjpe
Keyword(s):  
Young Patients ◽  
Case Series ◽  
Exploratory Laparotomy ◽  
Duodenal Perforation ◽  
High Morbidity ◽  
Peptic Ulcer Perforation ◽  
Ulcer Perforation ◽  
Full Diet ◽  
Endoscopic Clips ◽  
Endoscopic Clipping

Abstract Aims and Objectives: In an attempt to avoid the high morbidity and mortality associated with exploratory laparotomy in a patient of duodenal ulcer perforation (DUP), an attempt was made to treat patients with spontaneous DUP with endoscopic clips. Background: DUP is a common cause of surgical emergency. Traditional form of treatment includes nasogastric decompression, fluid resuscitation, and exploratory laparotomy or laparoscopy for repair. Considering the compromised state of such patients, endoscopic treatment and avoiding surgery will play a great role in preventing the further stress caused by surgery and facilitate quicker recovery. On thorough review of literature, we found few articles stating successful endoscopic clipping of iatrogenic duodenal perforation occurred during upper endoscopy. Our case series appears to be first of its kind reporting the use of endoclips for treating spontaneous (noniatrogenic) DUP. Materials and Methods: Three young male patients presenting with a short duration history of abdominal pain and vomiting and chest radiograph suggesting pneumoperitoneum were selected for endoscopic clipping. All of them were hemodynamically stable with near normal blood pressure and pulse rate. Under local anesthetic spray and mild sedation, endoscopic clipping was carried out along with supportive treatment. Postoperatively, patients were monitored clinically and radiographically and discharged after they could tolerate full diet. Results and Conclusion: We recommend that in selected group of young patients of DUP who have presented early and are hemodynamically stable, endoclips may be applied to approximate mucosa. With supportive conservative treatment offered, thereafter healing of perforation occurs without the need for laparotomy or laparoscopy for suturing the same.

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.

NSAIDS: A RISK FACTOR AFFECTING PEPTIC ULCER PERFORATION

2021 ◽  
pp. 9-9
Author(s):  
Neelkamal Gupta ◽  
Mangtani Jitendra K ◽  
Khandelwal Dheeraj K
Keyword(s):  
Peptic Ulcer ◽  
Statistical Correlation ◽  
Duodenal Perforation ◽  
Peptic Ulcer Perforation ◽  
Muscularis Mucosa ◽  
Time Duration ◽  
Ulcer Perforation ◽  
Medical College ◽  
Life Threatening ◽  
Gandhi Medical College

INTRODUCTION:Apeptic ulcer is a defect in the upper gastrointestinal mucosa that extends through the muscularis mucosa into deeper layers of the gut wall. Non-steroidal anti-inammatory drugs (NSAIDs) are the major risk factors for peptic ulcer disease.Long-term use of NSAIDs, however, can cause gastrointestinal (GI) ulcers and potentially life-threatening ulcer complications. MATERIALAND METHOD: The present study was conducted on 100 patients of peptic ulcer of either sex in Department of Surgery, Mahatma Gandhi Medical College & Hospital, Jaipur. History of any other co morbid illness and any drug being taken with its time duration were recorded in detail. RESULT AND DISCUSSION: From this study, it was observed that among the 69 patients of duodenal perforation, 73.91% were taking NSAID. Similarly among the 31 patients of gastric perforation 80.64% were taking NSAID. Overall total 76% patients were taking these drugs. CONCLUSION: It is concluded from this study that a strong statistical correlation was found between use of NSAIDs and peptic ulcer perforation.

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

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.

Proximal Duodenal Perforation in Three Dogs Following Deracoxib Administration

2010 ◽  
Vol 46 (4) ◽  
pp. 255-258 ◽  
Author(s):  
J. Brad Case ◽  
Jennifer L. Fick ◽  
Matthew B. Rooney
Keyword(s):  
Gastrointestinal Disease ◽  
Case Series ◽  
Exploratory Laparotomy ◽  
Clinical Findings ◽  
Duodenal Perforation ◽  
Pathological Findings ◽  
Duodenal Papilla ◽  
Major Duodenal Papilla ◽  
Septic Peritonitis ◽  
Duodenal Perforations

The purpose of this study was to describe the clinical and gross pathological findings, treatment, and outcome in three dogs receiving deracoxib that developed proximal duodenal perforation and subsequent septic peritonitis. Clinical findings were acute vomiting and anorexia following initiation of deracoxib therapy. Deracoxib dosages ranged from 2 to 3 mg/kg per os q 24 hours. In each dog, exploratory laparotomy revealed duodenal perforations approximately 1 cm orad to the major duodenal papilla. Two out of three dogs survived following exploratory laparotomy. Two of three dogs in the present case series received the approved deracoxib dosage. Dogs receiving deracoxib, even at labeled dosages, should be monitored judiciously for signs of gastrointestinal disease.

scholarly journals PEPTIC ULCER PERFORATION-INCIDENCE IN YOUNG PATIENTS IN WESTERN RAJASTHAN.

2017 ◽  
Vol 5 (7) ◽  
pp. 1257-1260
Author(s):  
Ratanraj a ◽  
◽  
Deepak Verma ◽  
PoojanM Purohit ◽  
Kshitij b ◽  
...  
Keyword(s):  
Peptic Ulcer ◽  
Young Patients ◽  
Peptic Ulcer Perforation ◽  
Ulcer Perforation

scholarly journals Peptic ulcer perforation in young Indians the causation and the trend

2017 ◽  
Vol 5 (1) ◽  
pp. 200
Author(s):  
Geeta Sabhnani ◽  
Akula Nyna Sindhu
Keyword(s):  
Young Adults ◽  
Peptic Ulcer ◽  
Young Adult ◽  
Duodenal Perforation ◽  
Peptic Ulcer Perforation ◽  
Adult Males ◽  
Ulcer Perforation ◽  
Surgical Emergencies ◽  
Causative Factors ◽  
History Of

Background: Peptic ulcer perforation is the commonest surgical emergencies in India. Recent emergency surgical procedures show an increasing trend in peptic ulcer perforation surgery in young adults. This study is carried out with an aim to understand the trend, causation and complications of peptic ulcer perforation in young Indians.Methods: A prospective observational study of young adult Indian patients operated for emergency peptic ulcer perforation for a 3 years period from January 2014 to January 2017 was carried out. The incidence, causative factors and the complications were analyzed.Results: In study of 150 patients, maximum incidence of 42.85% was seen in age group of 21 to 30 years that is young adults. 80% of them were males. 59% patients had blood group O. Association with smoking and alcoholism was seen in about 64% and 66.6% respectively. In about 13.33% there was an association seen with history of NSAID / steroid ingestion / treatment with proton pump inhibitors or H2antagonists.The duodenal perforation was found in 84.66%. In 90% the perforation was less than 1cm.Wound infection was the commonest complication among all patients. Mortality was seen in 3.33%.Conclusions: Peptic ulcer perforation shows increasing incidence in young adult males. The increased incidence shows association to smoking, alcoholism, irregular food habits, use of NSAIDS/steroids and overall stressed lifestyle. 

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.

scholarly journals Factors affecting morbidity and mortality in peptic ulcer perforation

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.

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.

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