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Results for “PEPTIC ULCER PERFORATION”

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PubMed1993

Perforated peptic ulcer disease in children: association of corticosteroid therapy.

Four children were treated at the Oregon Health Sciences University for perforated peptic ulcer disease over the last 15 years. All children were being treated for other severe underlying diseases at the time of perforation. All of the children were receiving corticosteroids; one was receiving ulcer prophylaxis. Presenting symptoms were those of a perforated viscus, and pneumoperitoneum was present in all patients. Simple closure and omental patching of the ulcer resulted in no operative mortality or morbidity. None of the ulcers have recurred. In reviewing the literature, corticosteroids were associated with perforated peptic ulcer disease in 17.8% of children with perforated peptic ulcer. Despite controversy regarding the role of corticosteroids in the causation of peptic ulcer, we recommend prophylaxis for all children receiving corticosteroids.

Child↗

PubMed1996

Laparoscopic and conventional closure of perforated peptic ulcer. A comparison.

BACKGROUND: After the first successful laparoscopic closure of a perforated peptic ulcer in 1990, 18 patients with laparoscopic closure were compared to 16 patients with conventional surgery. METHODS: The endpoint adverse events (complications), pain intensity, operation time, fever, leucocytosis, and duration of hospital stay showed no clinically relevant differences. RESULTS: Consumption of analgesics was lower in the laparoscopic group. CONCLUSIONS: Laparoscopic closure of perforated peptic ulcer is technically feasible. The safety of the method and the benefit for the patient need proof by means of a randomized controlled trial.

Adult↗

PubMed2001

Perforated peptic ulcer in an infant.

We describe a case of perforated peptic ulcer (PPU) in a 9-month-old boy. Abdominal distension was the first clinical sign of PPU. Before he developed abdominal distension, the patient had suffered from an upper respiratory tract infection with fever for about 2 weeks, which was treated intermittently with ibuprofen. A plain abdominal radiograph revealed pneumoperitoneum with a football sign. At laparotomy, a 0.8-cm perforated hole was found over the prepyloric area. Simple closure with omental patching was performed after debridement of the perforation. Pathologic examination showed chronic peptic ulcer with Helicobacter pylori infection. The postoperative course and outcome were satisfactory. The stress of underlying disease, use of ibuprofen, blood type (A), and H. pylori infection might have contributed to the development of PPU in this patient. PPU in infancy is rare and has a high mortality rate; early recognition and prompt surgical intervention are key to successful management.

Humans↗

PubMedDate not supplied

Prospective evaluation of simple suture in the surgical treatment of perforated peptic ulcer.

In a prospective study aimed at evaluating a safe treatment for perforated peptic ulcer in tropical African conditions 205 patients who presented with perforation of a peptic ulcer in South-Eastern Nigeria during the ten year period January 1973 to December 1982 were treated by simple suture. The ulcers were classified at operation from appearance and feel as acute in 155 patients (75.6%), and chronic in the remaining 50 patients (24.4%). Of this number 21 patients (10.2%) died post-operatively. All 21 patients had chronic pyloroduodenal ulcers which were complicated by haemorrhagic in 10 patients (5.0%) and extensive scarring of the duodenum and pyloric stenosis in 9 patients (4.4%). By way of contrast, no patient with acute pyloroduodenal ulcer died and none was known to suffer from recurrent dyspepsia at 6 months to 1 year follow-up. These results clearly show that simple suture is adequate and safe treatment for perforated acute pyloroduodenal ulcer; however, this form of treatment carries an unacceptably high mortality in those patients with perforated chronic pyloroduodenal ulcers. These patients should, where feasible, be treated by definitive ulcer - curative surgery.

Adult↗

PubMed2005

Systematic review comparing laparoscopic and open repair for perforated peptic ulcer.

BACKGROUND: The advantages of laparoscopic over open repair for perforated peptic ulcer are not as obvious as they may seem. This paper summarizes the published trials comparing the two approaches. METHODS: Two randomized prospective, five non-randomized prospective and eight retrospective studies were included in the analysis. Relevant trials were identified from the Medline/Pubmed database and the reference lists of the retrieved papers were then analysed. The outcome measures used were operating time, postoperative analgesic requirements, length of hospital stay, return to normal diet and usual activities, and complication and mortality rates. Published data were tested for heterogeneity by means of a chi2 test. Meta-analysis methods were used to measure the pooled estimate of the effect size. In total, 1113 patients are represented from 15 selected studies, of whom 535 were treated by laparoscopic repair and 578 by open repair; 102 patients (19.1 per cent) underwent conversion to open repair. RESULTS: Statistically significant findings in favour of laparoscopic repair were less analgesic use, shorter hospital stay, less wound infection and lower mortality rate. Shorter operating time and less suture-site leakage were advantages of open repair. Three variables (hospital stay, operating time and analgesic use) were significantly heterogeneous in the papers analysed. CONCLUSION: Laparoscopic repair seems better than open repair for low-risk patients. However, limited knowledge about its benefits and risks compared with open repair suggests that the latter, more familiar, approach may be more appropriate in high-risk patients. Further studies are needed.

Analgesics↗

PubMed1956