GASTRODUODENAL PERFORATION, A FREQUENT SURGICAL EMERGENCY. REVIEW AND DESCRIPTIVE STUDY

INTRODUCTION Perforated gastroduodenal ulcer represents a common surgical emergency and is associated with a morbimortality close to 40-50%. HP infection, tobacco and alcohol and some socioeconomic aspects represent the most commonly described risk factors. MATERIAL AND METHODS A descriptive and retrospective study was performed between 2018-2020. A total of 40 patients with a history of gastroduodenal perforation were selected. Data corresponding to: sex, age, ulcer location, treatment, tobacco and alcohol consumption, HP infection (presence or not of eradicating treatment) and other potential risk factors were collected and analysed. The aim of the study is to assess how new lifestyle changes, the evolution and improvement in the management of PH infection and the general decrease in smoking have modified the classic profile of patients with gastroduodenal perforations. RESULTS Gastroduodenal perforations predominated in the fifth/sixth decade of life (mean age 59 years). Although a predominance in men is described in the literature, in our sample no significant sex differences were found (1:1 ratio). The most frequent location was duodenal and the reference surgical treatment was primary suture + epipoplasty. Only one third of the patients had a known history of peptic ulcer. CONCLUSIONS Gastroduodenal perforations are a major problem for the on-call surgeon. It is essential to know the current risk factors and their potential relationship with morbimortality and postoperative evolution in order to guarantee the optimal management of these patients.

Acute respiratory effect of transpyloric feeding for respiratory exacerbation in preterm infants

ObjectivesGastroesophageal reflux may exacerbate chronic lung disease in preterm infants. We evaluated the short-term effects of transpyloric feeding on respiratory status in preterm infants during mechanical ventilation.MethodsWe retrospectively collected data from the hospital information management system. To evaluate the effect of transpyloric feeding on oxygenation, we compared changes in SpO2/FiO2 ratios before and after commencing transpyloric feeding by a piecewise linear regression model.ResultsWe examined 33 infants (median gestational age, 25.4 weeks; median birth weight, 656 g) who underwent transpyloric feeding. All tubes were placed at the bedside without fluoroscopy. No cases of unsuccessful placement, gastroduodenal perforation, or tracheal misinsertion occurred. Transpyloric feeding began at a median age of 18 (interquartile range, 15–23) days. Mean SpO2/FiO2 (±SD) ratios were 391 (±49), 371 (±51), 365 (±56), and 366 (±53) 72–96 h before, 0–24 h before, 48–72 h after, and 96–120 h after starting transpyloric feeding, respectively. The rate of change per hour of SpO2/FiO2 ratios increased 48–120 h after compared with 0–96 h before transpyloric feeding (0.03 [95% confidence interval, −0.10 to 0.17] vs. −0.29 [−0.47 to −0.12]) (p=0.007). No apparent changes occurred in the mean airway pressure, amplitude pressure, or pCO2.ConclusionsTranspyloric feeding during mechanical ventilation can prevent the deterioration of oxygenation without major complications at the stage of respiratory exacerbation in preterm infants.

The surgical management of benign gastroduodenal perforation

Gastric perforations may be spontaneous or traumatic and most of the spontaneous perforation is due to peptic ulcer disease. Improved medical management of peptic ulceration has reduced the incidence of perforation, but still remains a common cause of peritonitis. The management of perforated peptic ulcer disease is still a subject of debate. The majority of perforated peptic ulcers are caused by Helicobacter pylori, so apart from simple closure, definitive surgery is not usually required. Perforated peptic ulcer is an indication for operation in nearly all cases except when the patient is unfit for surgery. However, with the current advances in anaesthetic approach and with the high incidence of intra-abdominal abscesses and sepsis, non-operative management has largely been abandoned.

Gastroduodenal Bleeding and Perforation in Diabetic Patients with Metabolic Syndrome (the Results of a 15-Year Observation of City Residents with Intensive Urbanization)

Background: The prevalence of bleeding and perforation against the diabetes mellitus, obesity and metabolic syndrome (MetS) is studied not sufficiently. Methods: The period of collecting the material was 15 years (2003-2017). The observation analysis was conducted for the patients at polyclinics observations, by the doctors of first-aid, in the surgical departments of the Astana City, Kazakhstan. The number of first-aid visits to patients, the medical cards of the patients with gastroduodenal perforation (GDP) and gastroduodenal bleeding (GDB) were analyzed. Results: The rate of annual growth of indices of overall morbidity Rgm=1.0%, obesity in combination with diabetes was Ro=1.7%; and morbidity with metabolic syndrome was Rm=3.1%. The diagnosis of GDP was revealed in 0.63 men with MetS for every 100000 urban people. The diagnosis of GDB was registered in 2.12 men for 100000 urban people. The index of the annual growth in patients with MetS had the tendency to the growth (Rms=3.1%). Conclusion: The high medical and social significance of diseases of the digestive system among the adult population in Kazakhstan is determined by the annual increase in the incidence rate and a clear decrease in the quality of life of such patients, which necessitates the search for scientifically based ways to improve medical care for this population.

Presence of Helicobacter pylori infection in gastroduodenal perforations

Background: Gastroduodenal perforations constitute one of the commonest surgical emergencies encountered. Helicobacter pylori is a gram negative bacterium that has infected more than half the world’s population. The most commonly recognized manifestation of H. pylori infection in India is peptic ulcer disease. Although the relationship between H. pylori infection and peptic ulcer has been well defined, the relationship of H. pylori infection with gastroduodenal perforation is still controversial. The objective of the study was to determine the presence of H. pylori in gastroduodenal perforations.Methods: We conducted a prospective study, noting the number of cases which turned out to be positive for H. pylori in cases of gastroduodenal perforations intraoperatively, using rapid urease test.Results: Out of 100 cases of gastroduodenal perforations operated, 74% were positive for the test. Gastric perforations positive for the test were 81.4% and duodenal perforations positive for the test were 68.42%.Conclusions: There is a positive attribution between H. pylori infection and gastroduodenal perforations.

Fungal Peritonitis Due to Gastroduodenal Perforation: Diagnostic and Treatment Challenges

The gastrointestinal tract perforation is one of the leading causes of acute abdomen. Mycotic infections have become a significant clinical problem over the last few decades. Despite the advance in diagnostics and treatment of patients with fungal peritonitis, the mortality remains high.Objective. The objective of the study was to determine the type and incidence of causative pathogens of acute peritonitis in patients with gastroduodenal perforation, and to estimate the impact of microbial flora on the disease outcome.Materials and methods. We performed a retrospective study among 83 adult patients with acute peritonitis due to gastroduodenal perforation treated at our centre.Results. A total of 40 mycotic agents were isolated in 39 of the abdominal samples. The primary mycotic isolates were Candida albicans (52.5%) and C. glabrata (64.3%); C. krusei (14.3%) and C. tropicalis (7.1%) predominated among non-albicans Candida species (35.0%). The most common bacterial agents were Escherichia coli (24.0%) and Enterococcus spp. (24.0%). 77.1% of all enrolled patients survived, and 19 of them deceased due to sepsis and multiple organ dysfunction syndrome.Conclusion. Candida albicans is the most common mycotic pathogen in patients with acute peritonitis due to gastroduodenal perforation. It is obligatory to examine the peritoneal fluid samples for bacterial and fungal pathogens with determination of their antimicrobial susceptibility profile. Timely initiation of adequate treatment and multidisciplinary approach is crucial for the outcome of patients with fungal peritonitis.