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PubMedDate not supplied

The features of perforated peptic ulcers in conventional computed tomography.

BACKGROUND/AIMS: CT is not usually of priority to evaluate the pathology of the gastrointestinal tract, especially perforated peptic ulcer. However CT might be employed when the presentation is atypical. The study was to summarize the imaging features of perforated peptic ulcer in conventional CT and assess its ability of detecting perforated peptic ulcer. METHODOLOGY: The CTs of 14 consecutive patients with perforated peptic ulcer confirmed by operation were retrospectively reviewed. The CTs were obtained after intravenous contrast medium, but oral contrast medium was administered only in 5 patients. The CT findings were correlated with surgical findings. RESULTS: Among these 14 patients, all the 14 patients (100%) had extraluminal air accumulation, 10 patients (71%) had abnormal fluid accumulation, and 5 (36%) patients had inflammatory changes in surrounding soft tissues. In addition, conventional CT could only demonstrate the site of perforation in 5 patients (36%) of them. CONCLUSIONS: Conventional CT was valuable in the diagnosis of perforated peptic ulcer, and pneumoperitoneum was the most common feature. However the ability of conventional CT in localizing the site of perforation was poor.

Adult↗
PubMed1991

[Treatment of perforated peptic ulcer using the round ligament under celioscopy].

We propose an original technique of treatment of perforated peptic ulcer with celioscopic monitoring which has principles and indications similar to those of simple surgical suture via laparotomy. The procedure consists in obliterating the ulcerous perforation with the round ligament (RL) that has previously been predicled from its insertion on the liver, under celioscopy. The umbilical end of the RL is then caught with a Dormia probe inserted through the perforation with a fibrogastroscope. By pulling the probe, the RL is then inserted into the perforation and obturates it. Peritoneal washing and transcutaneous infrahepatic drainage complete the procedure. This was proposed to 9 patients (8 M, 1 F) with a mean age of 41 years (24-59) having ulcers perforated for less than 6 hours. The obliteration of the perforation using the RL was performed easily in 7 cases. In 3 cases, the procedure could not be carried out, either because the diameter of the perforation exceeded 1.5 cm (n = 2) or because of purulent peritonitis (n = 1). No postoperative complications occurred. The endoscopic control showed healed ulcers in all cases after 5 weeks of treatment with anti-H2 drugs. These still preliminary results suggest that the celioendoscopic treatment of perforated peptic ulcers might be proposed whenever vagotomy does not seem to be absolutely necessary, especially in cases of acute ulcer occurring in younger subjects. In comparison with laparotomy, this procedure prevents parietal sequellae and improves the postoperative comfort. This procedure might also be proposed as an alternative to Taylor's procedure, thus avoiding the diagnostic errors and delays in surgery that are inherent in this therapeutic method.

Adult↗
PubMedDate not supplied

Risk factors predicting operative mortality in perforated peptic ulcer disease.

Following the introduction of H2-blockers and proton pump inhibitors, there has been a sharp decrease in elective peptic ulcer surgery. However, emergency operations for complications such as perforation are on the rise. This study was undertaken to review the factors which determine mortality following emergency surgery for peptic ulcer perforation. A prospective study of all patients who underwent surgery at our institute for peptic ulcer perforation between September 1999 and August 2001 was carried out. One hundred seventy-four patients underwent surgery for perforated peptic ulcer. Risk of death was related to age more than 60 years, shock at presentation, delay more than 24 hours prior to surgery and size of perforation more than 5 mm. Perforated peptic ulcer disease remains a frequent clinical problem associated with a significant postoperative mortality.

Adolescent↗
PubMed1983

Reassessment of Graham-Steele closure in acute perforated peptic ulcer.

We studied 67 patients who had operation for perforated peptic ulcer. Operative treatment included plication with omentum (Graham closure) in 27 patients, vagotomy and pyloroplasty in 32 patients, or vagotomy and antrectomy in eight patients, depending on antecedent ulcer history, degree of contamination, and general patient condition. Mortality was high with simple closure in patients with long-standing perforation or associated disease. Early complications associated with Graham closure included rebleeding, perforation, and obstruction. There were no deaths or major complications related to vagotomy and pyloroplasty. In selected patients, definitive operation is safe and produces excellent long-term results.

Acute Disease↗
PubMed2002

Surgery for perforated peptic ulcers at Prachomklao Hospital.

The results of surgical treatment of perforated peptic ulcers in 330 patients, during the 12 year period from October 1989 to September 2001, were analysed. One hundred and ninety two patients were treated by simple closure and 138 patients by definitive surgery. There were no differences in age incidence, occupation, state of shock upon admission and duration of symptoms between the two groups. Complication rates were 30.21 and 19.57 per cent in simple closure and the definitive surgery group respectively. Mortality rate was 1.56 per cent in simple closure and no death in the definitive surgery group. Thirty-four patients in the simple closure group required definitive surgery subsequently for repeated perforation. It may be concluded that, except for perforation of acute duodenal ulcer, definitive surgery should be the treatment of choice in patients with a perforated peptic ulcer. Parameters used to decide whether to perform definitive surgery include the patient's condition and experience of the surgeon and surgical team.

Adult↗
PubMed1992

Perforated peptic ulcer. A further application of laparoscopic surgery.

A case of perforated peptic ulcer in a patient with cervical myelopathy due to osteophyte cervical canal stenosis complicated by the sudden onset of abdominal pain is described. Diagnostic laparoscopy revealed a perforated peptic ulcer in the anterior wall of the duodenal cap. Laparoscopic treatment was suitable for this condition.

Aged↗
PubMed1989

A randomized trial of nonoperative treatment for perforated peptic ulcer.

To determine whether surgery could be avoided in some patients with perforated peptic ulcer, we conducted a prospective randomized trial comparing the outcome of nonoperative treatment with that of emergency surgery in patients with a clinical diagnosis of perforated peptic ulcer. Of the 83 patients entered in the study over a 13-month period, 40 were randomly assigned to conservative treatment, which consisted of resuscitation with intravenous fluids, institution of nasogastric suction, and intravenous administration of antibiotics (cefuroxime, ampicillin, and metronidazole) and ranitidine. Eleven of these patients (28 percent) had no clinical improvement after 12 hours and required an operation. Two of the 11 had a perforated gastric carcinoma, and 1 had a perforated sigmoid carcinoma. The other 43 patients were assigned to immediate laparotomy and repair of the perforation. One of these patients was found to have a perforated gastric carcinoma. The overall mortality rates in the two groups were similar (two deaths in each, 5 percent), and did not differ significantly in the morbidity (infection, cardiac failure, or renal failure) rates (40 percent in the surgical group and 50 percent in the nonsurgical group). The hospital stay was 35 percent longer in the group treated conservatively. Patients over 70 years old were less likely to respond to conservative treatment than younger patients (P less than 0.05). We conclude that in patients with perforated peptic ulcer, an initial period of nonoperative treatment with careful observation may be safely allowed except in patients over 70 years old, and that the use of such an observation period can obviate the need for emergency surgery in more than 70 percent of patients.

Age Factors↗
PubMed1994

Alternative laparoscopic management of perforated peptic ulcers.

Surgery--namely, suture closure-is still the treatment of choice for perforated peptic ulcers, despite the proven efficacy of Taylor's conservative approach. Such conservative management, however, has been proven less effective in high-risk patients and those with perforations more than 12 h old. Here we suggest alternative laparoscopic treatments for perforated peptic ulcers. We have treated laparoscopically six patients (one F, five M; mean age 57.6 years; range 31-81 years); the mean duration of the operation was 52 min; the median hospital stay was 7 days (6-15 days); H2-blockers, antibiotics, and fluids were administered in the p.o. course; the follow-ups range from 6 to 18 months. On the basis of our experience, the treatment of choice for perforated peptic ulcers is Taylor's conservative procedure and laparoscopic drainage of the abdominal cavity when there is mild peritoneal reaction (usually less than 6 h from the onset of perforation). In case of remarkable peritonitis (usually more than 12 h), it is mandatory to add an accurate lavage. When the site of perforation is concealed by the peritoneal inflammation it should not be searched; when visible, it might be obliterated with the round ligament or an omental tissue strand, particularly if larger than 1 cm in diameter.

Adult↗
PubMed2000

Perforated peptic ulcer: laparoscopic approach.

OBJECTIVES: To examine the suitability of a laparoscopic approach for treatment of perforated peptic ulcer. DESIGN: Retrospective non-randomised study. SETTING: District Community Hospital. METHODS: 30 patients who presented with perforated peptic ulcers between November 1992 and October 1997 INTERVENTIONS: 16 patients were operated on laparoscopically, and 14 by open operation (as there was no surgeon available with laparoscopic experience). MAIN OUTCOME MEASURES: Morbidity and mortality. RESULTS: The laparoscopic operation was successful in all but one patient, whose operation was converted to an open procedure because we could not see the ulcer adequately. Duration of operation and postoperative nasogastric aspiration, analgesic requirements, hospital stay, morbidity, and mortality were similar in the two groups. CONCLUSIONS: Laparoscopic repair of a perforated peptic ulcer is safe in selected patients in whom a laparotomy should be avoided.

Adult↗
PubMed1999

Laparoscopic and open operation in patients with perforated peptic ulcer.

OBJECTIVES: To compare the results of laparoscopic and open operations in patients with perforated peptic ulcer. DESIGN: Retrospective analysis. SETTING: Central hospital, Norway. SUBJECTS: 74 patients (36 men, 38 women, median age 69.5 years (18-86)) admitted with perforated peptic ulcers from November 1991-May 1996. INTERVENTIONS: Suture of the ulcer, patching with the greater omentum and lavage, in 49 by open operation and 25 laparoscopically. MAIN OUTCOME MEASURES: Duration of postoperative hospital stay, operating time, number of doses of analgesic, postoperative body temperature, complications, and mortality. RESULTS: There was a significant difference (p = 0.0001) in median operating time: 100 minutes (range 48-160) in the laparoscopic group and 50 minutes (range 20-160) in the open group. The median hospital stay was 8 days in both groups: range 3-23 days in the laparoscopic group and 2-28 days in the open group. There were no significant differences between the two groups with regard to median number of doses of analgesic, median body temperature, complications or mortality. CONCLUSION: Laparoscopic operation for perforated peptic ulcer can be considered as safe as open operation.

Adolescent↗
PubMedDate not supplied

Panendoscopic finding of perforated peptic ulcer (PPU).

BACKGROUND/AIMS: The purpose of this research was to investigate whether endoscopy can identify specific signs in the area of the lesion in patients with undiagnosed perforated peptic ulcer. METHODOLOGY: From February 1990 to September 1999, a total of 435 cases of perforated peptic ulcer were diagnosed after surgery at Changhua Show Chwan Memorial Hospital. Among them, 30 patients had received endoscopic examination before surgery and were diagnosed with perforated peptic ulcer during surgery. RESULTS: One or more of the following signs were found by endoscopy in all patients: 1) a deep ulcer with a visible perforation hole (21/30, 70%); 2) formation of small air bubbles at the ulcer site (16/30, 53.3%); 3) duodenal bulb unable to dilate normally or at all during air inflation (12/30, 40%); and 4) exudative substance leaking from or covering the ulcer site (16/30, 60%). CONCLUSIONS: Endoscopy cannot be applied as a routine method establishing a perforated peptic ulcer diagnosis. However, when the above signs are observed on endoscopy, the physician should highly suspect the presence of perforated peptic ulcer.

Adult↗
PubMed1996

A randomized study comparing laparoscopic versus open repair of perforated peptic ulcer using suture or sutureless technique.

OBJECTIVE: This study compares laparoscopic versus open repair and suture versus sutureless repair of perforated duodenal and juxtapyloric ulcers. BACKGROUND DATA: The place of laparoscopic repair of perforated peptic ulcer followed by peritoneal toilet of the peritoneal cavity has been established. Whether repair of the perforated peptic ulcer by the laparoscopic approach is better than conventional open repair and whether sutured repair is better than sutureless repair are both undetermined. METHODS: One hundred three patients were randomly allocated to laparoscopic suture repair, laparoscopic sutureless repair, open suture repair, and open sutureless repair. RESULTS: Laparoscopic repair of perforated peptic ulcer (groups 1 and 2) took significantly longer than open repair (groups 3 and 4; 94.3 +/ 40.3 vs. 53.7 +/ 42.6 minutes: Student's test, p < 0.001), but the amount of analgesic required after laparoscopic repair was significantly less than in open surgery (median 1 dose vs. 3 doses) (Mann-Whitney U test, p = 0.03). There was no significant difference in the four groups of patients in terms of duration of nasogastric aspiration, duration of intravenous drip, total hospital stay, time to resume normal diet, visual analogue scale score for pain in the first 24 hours after surgery, morbidity, reoperation, and mortality rates. CONCLUSIONS: Laparoscopic repair of perforated peptic ulcer is a viable option. Sutureless repair is as safe as suture repair and it takes less time to perform.

Adult↗
PubMed2004

[Laparoscopic surgery for perforated peptic ulcer].

Laparoscopic surgery has become the treatment of choice for the management of perforated peptic ulcer. The advantages of laparoscopic repair for perforated peptic ulcer include less pain, a short hospital stay, and an early return to normal activity. Although the operation time of laparoscopic surgery is significantly longer than that of open surgery, laparoscopic technique is safe, feasible, and with morbidity and mortality comparable to that of the conventional open technique. To benefit from the advantages offered by minimally invasive laparoscopic technique, further study will need to determine whether laparoscopic surgery is safe in patients with generalized peritonitis or sepsis.

Humans↗