Mortality and Morbidity in Peptic Ulcer Perforation: A Comparison between Radical Open Repair vs Conservative Laparoscopic Repair

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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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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The growing role of laparoscopic repair in patients with early diagnosed peptic ulcer perforation

Turkish Journal of Surgery ◽

10.5152/ucd.2014.2640 ◽

2014 ◽

Vol 30 (3) ◽

pp. 120-124 ◽

Cited By ~ 1

Author(s):

Muhammet Ferhat Celik ◽

Ahmet Cem Dural ◽

Cevher Akarsu ◽

Mustafa Gokhan Unsal ◽

Ilhan Gok ◽

...

Keyword(s):

Peptic Ulcer ◽

Laparoscopic Repair ◽

Peptic Ulcer Perforation ◽

Ulcer Perforation

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POMPP Score: Evaluation of Mortality and Morbidity in Patients with Secondary Peritonitis

International Journal of Innovative Research in Medical Science ◽

10.23958/ijirms/vol03-i04/01 ◽

2018 ◽

Vol 3 (04) ◽

Author(s):

Shergill J. S. ◽

Sharma S. ◽

Kaur R. ◽

Sunkaria B. L

Keyword(s):

Peptic Ulcer ◽

Perforated Peptic Ulcer ◽

Exploratory Laparotomy ◽

Gastrointestinal Perforation ◽

Predictive Score ◽

Peptic Ulcer Perforation ◽

Mortality And Morbidity ◽

Ulcer Perforation ◽

Tract Perforation ◽

Time Of Admission

Background: Gastrointestinal tract perforation is one of the common surgical emergency all over the world. Menekse et al devised POMPP score (predictive score of mortality in perforated peptic ulcer) to predict the morbidity and mortality in peptic ulcer perforation. Aim: The objective of this study was to assess the validity of POMPP score in peptic ulcer perforation and to assess its usefulness in gastrointestinal perforation due to causes other than the peptic ulcer. Methods: Fifty consecutive cases, who had undergone exploratory laparotomy for gastrointestinal perforation peritonitis, were included in the study. “These patients were assessed at the time of admission on the basis of Age >65 years, BUN >45mg/dl (Blood Urea Nitrogen) and Albumin <1.5g/L and a score of 1 point each had been given”. The total score was compared with the outcome of the disease in relation with mortality. Results: In our study, 42% of gastrointestinal perforation were due to peptic ulcer, 22 % due to small bowel perforations (18% Ileal and 4 % Jejunal), 14 % due to trauma and 22 % due to miscellaneous causes. Morbidity is common after gastrointestinal perforation and it ranges from 17-63% whereas mortality ranges from 6-14%. Conclusions: POMPP score is easy and valid scoring system for peptic ulcer perforation. Early detection of high risk peptic perforation cases, allow other supportive treatment modality apart from surgery which can decrease the mortality. However, this score is not valid in perforation due to causes other than peptic ulcer.

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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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Is History of Ulcer an Adverse Factor for Laparoscopic Repair of Peptic Ulcer Perforation?

The American Surgeon ◽

10.1177/000313481508100217 ◽

2015 ◽

Vol 81 (2) ◽

pp. 84-86

Author(s):

Hung-Chieh Lo ◽

Li-Ting Su ◽

Han-Tsung Cheng ◽

Yu-Chun Wang ◽

Chi-Hsun Hsieh

Keyword(s):

Peptic Ulcer ◽

Laparoscopic Repair ◽

Peptic Ulcer Perforation ◽

Ulcer Perforation ◽

History Of ◽

Adverse Factor

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A HOSPITAL BASED STUDY OF INCIDENCE OF PEPTIC ULCER PERFORATION IN YOUNG ADULTS

10.36106/ijsr/4538019 ◽

2021 ◽

pp. 25-27

Author(s):

Ganesh Chandra Karan ◽

Mridul Rai ◽

Debarshi Jana

Keyword(s):

Peptic Ulcer ◽

Positive Family History ◽

Perforated Peptic Ulcer ◽

World Population ◽

Ulcer Formation ◽

Peptic Ulcer Perforation ◽

Female Ratio ◽

Mortality And Morbidity ◽

Ulcer Perforation ◽

Associated Risk Factors

Background: Peptic ulcer formation affects about 2-10% of world population every year with higher incidence in younger individuals. Being a surgical emergency, it has higher mortality and morbidity. Thus, the aim of our study was to evaluate the incidence of peptic ulcer perforation based on gender, age and also to study its associated risk factors, clinical presentations, site along with surgical management and complications. Materials & Methods: 75 patients diagnosed with perforated peptic ulcer were included and this study was conducted in the Upgraded Department of Surgery, Darbhanga Medical College and Hospital, Laheriasarai, Bihar. Structured performa was prepared to obtained details of patients. Results: 76% of patients in our study were males and 24% were females with male and female ratio 1:3.16. The prevalence of perforation was high in age group 20-30 years (30.7%). 62.7% of cases had positive family history and the incidence was in the patients who consumed non-vegetarian (84.8%), spicy (61.4%) and oily (69.5%) foods. Frequently observed clinical presentation were abdominal pain followed by tenderness and rigidity and gas under diaphragm. The common site of perforation was duodenum (62.7%) and most of the cases were treated by closure with omental patch (81.3%). The post-surgical complications frequently observed were wound infection (30.6%) and chest infection (28%). Conclusion: Peptic ulcer perforation is common disorder of gastrointestinal tract, now affecting younger adults with male preponderance. It is associated with unwanted health and economic issues. Therefore, earlier management is only the way to minimize complications and mortality

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