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At least 289 records · Page 16Linked to original sources
PubMed2003

Perforated peptic ulcer: main factors of morbidity and mortality.

It is well stated in the literature that medical treatment for peptic ulcer is based on a combination of proton pump inhibitors (PPIs) and antibiotics to eradicate Helicobacter pylori. This treatment is associated with a high rate of immediate success and a low rate of recurrence at 12 months, although it is not effective in all patients. Peptic ulcer (PU) perforation is a serious problem that leads to high complication and mortality rates. Surgical treatment, with its various possibilities, constitutes the ideal treatment. Surgical intervention in these cases, however, can be directed to treating the perforation alone, or it can offer definitive treatment of the ulcer itself. With the hope of establishing why such complications and mortality were seen in the patients in our hospital population, we gathered the facts about PU perforations and the types of surgery performed. We studied 210 consecutive patients (150 men, 60 women) who had undergone surgery at our hospital because of perforation between January 1, 1990 and December 31, 2000. The patients' median age was 53.0 +/- 20.6 years (men 47.7 +/- 17.3 years; women 66.3 +/- 22.0 years). Altogether, 86 patients had significant associated illnesses, 62 were admitted more than 24 hours after the perforation, and 25 were admitted in shock. We performed resections in 10 patients; 88 patients were treated by suturing the perforation with or without a patch of epiploon; and 112 underwent a troncular vagotomy with drainage (VT + Dr). A total of 21 patients died (10%). Significant risk factors that led to complications were identified by statistical studies. They were a perforation that had been present more than 24 hours, the coexistence of significant associated illnesses, and resection surgery. The significant risk factors that led to death were the presence of shock at admission, the coexistence of significant illnesses, and resection surgery. There was no statistically significant difference concerning morbidity and mortality between simple closure of the perforation and definitive surgery (VT + Dr).

Age Distribution↗
PubMed2006

Xanthogranulomatous pseudotumor of stomach induced by perforated peptic ulcer mimicking a stromal tumor.

Perforation is a serious complication of peptic ulcer disease occurring in 5% of such patients. Occasionally, the perforation may be sealed off by the omentum or the adjacent organs. Sealed perforated ulcer with pseudotumor formation is very rarely encountered. Here we present a case of gastric pseudotumor induced by perforation of a peptic ulcer. The imaging features in a barium sulfate study and computed tomography mimic an intramural tumor of the stomach.

Diagnosis, Differential↗
PubMedDate not supplied

Simple closure and follow up H2 receptor antagonists for perforated peptic ulcer--immediate survival and symptomatic outcome.

There is controversy over the optimum treatment of perforated peptic ulcer. Non-operative management is associated with a high incidence of subsequent operation while immediate definitive surgery is associated with a high initial peri-operative mortality. We have a policy of simple closure and follow up H2-receptor antagonists. This study reviews 100 consecutive patients to identify immediate survival and subsequent symptomatic results of this surgical policy. The mean age was 49 years with 24 patients over 70 years. Sixteen were taking H2-receptor antagonists and 20 taking non-steroidal anti-inflammatory drugs on admission. Simple closure was performed in 94 and six had definitive surgery as their first procedure. The 30 day mortality was 6% (1% for < 70 yrs n = 76, 20% for > 70 yrs n = 24). Complete follow up was achieved in 90%, (range 2-80 months). Seventy-four percent were asymptomatic, 13% intermittently symptomatic and 7% had continuous symptoms. Only five patients (6%) required subsequent definitive surgery. The policy of simple closure and follow up H2 receptor antagonists for perforated peptic ulcer is safe and effective in the long term.

Adolescent↗
PubMed1989

Non-steroidal anti-inflammatory drug ingestion: retrospective study of 272 bleeding or perforated peptic ulcers.

The ingestion of non-steroidal anti-inflammatory drugs (NSAID) in 272 patients with bleeding or perforated peptic ulcer was compared with 272 age/sex matched controls. A significantly higher proportion of patients with gastric ulcers had received NSAID than those with duodenal ulcers. Twelve of 90 (13%) patients admitted with bleeding duodenal ulcers had received NSAID compared with 11 of 26 (42%) patients with bleeding gastric ulcers (P = 0.003). Sixteen of 132 (12%) patients with perforated duodenal ulcer were taking NSAID compared with 8 of 24 (33%) patients with perforated gastric ulcer. Thirty eight percent of patients with both bleeding and perforated gastric ulcers had received NSAID compared with 13% bleeding and perforated duodenal ulcers (P less than 0.002). This study confirms the association of NSAID and complicated peptic ulcer in patients of over 65 years and highlights the particular susceptibility of the gastric mucosa to their injurious effect.

Adult↗
PubMed2000

Smoking and alcohol intake as risk factors for bleeding and perforated peptic ulcers: a population-based cohort study.

Both the incidence of and mortality from bleeding and perforated peptic ulcers are increasing. We assessed the association between smoking, intake of alcohol (including type of alcoholic beverage), and risk of a complicated peptic ulcer in a population-based study of 26,518 Danish subjects followed up for an average of 13.4 years. There were 214 cases of incident bleeding and 107 cases with perforated ulcers. We estimated relative risks (RRs) for incident bleeding and perforated peptic ulcers using Poisson regression analysis. Smoking more than 15 cigarettes per day compared with never smoking increased the risk of a perforated ulcer more than threefold [RR = 3.5; 95% confidence interval (CI) = 1.7-7.1)]. Drinking more than 42 drinks per week increased the risk of a bleeding ulcer fourfold (RR = 4.4; 95% CI = 2.3-8.3) compared with drinking less than one drink per week. Using the same comparison group, subjects who drank more than 21 drinks per week but no wine were at a higher risk of a bleeding ulcer (RR = 8.8; 95% CI = 2.2-35) than drinkers of the same amount of alcohol, but with more than 25% of their intake as wine (RR = 2.4; 95% CI = 1.0-6.0).

Adult↗
PubMed1987

Perforated peptic ulcer--a complication in acute salicylate intoxication.

A patient with perforated peptic ulcer following acute salicylate intoxication is presented. The patient had reversible renal failure requiring dialysis therapy, but no abdominal symptoms were noticed until six days after arrival. At this time haematemesis and melaena were observed. Symptoms and objective findings were vague, but further investigations revealed a perforated prepyloric ulcer, which was successfully treated with cimetidine, The delay from intoxication to symptoms has previously been described and might be due to the analgetic properties of salicylates.

Acute Disease↗
PubMed1971

Treatment and mortality of perforated peptic ulcer: a survey of 852 cases.

All proved cases of perforated peptic ulcer occurring in the Greater Vancouver area during the decade 1959-1968 have been studied. The incidence of perforation was approximately 10 per 100,000 population. The mean age was 55 years and the peak age incidence was in the fifth decade. The site of perforation was pyloroduodenal in 88% of cases and simple closure was the treatment employed in 81%. The overall mortality rate was 18.3% and one-third of these fatalities were due to misdiagnosis. The operative mortality rate was 9%.The overall mortality rate was significantly greater among women and the elderly, in gastric perforations, and in perforations occurring between 11 p.m. and 8 a.m.A close correlation was found between operative mortality rate and the time interval between perforation and operation. This elapsed time was found to be significantly greater among women and the elderly, in gastric perforations and in perforations occurring during the night.

Adolescent↗
PubMed2005

[Perforated peptic ulcer--a 12-year material].

BACKGROUND: We aimed to explore patient characteristics, diagnostic and surgical procedures and results of treatment of perforated peptic ulcer at our hospital, and determine prognostic factors for death and postoperative complications. MATERIAL AND METHODS: Data were collected retrospectively from 102 patients with perforated peptic ulcer identified from a broad case file search of 590 patients from 1992 to 2003. Prognostic factors for dead and post-operative complications were analysed using both uni- and multivariate analyses. RESULTS: 48 men and 54 women, median age 71 (25 - 94) were evaluated. Surgery was performed in 100 patients, 2 received conservative treatment. 55 patients had perforated gastric ulcers (including prepyloric ulcers), and 47 patients had perforated duodenal ulcers. Out of the 100 patients who underwent surgery, 22 died and 39 suffered postoperative complications. By univariate analysis, high age, high ASA score and a long interval between initial symptoms and surgery were significantly associated with death (p < 0.01) and postoperative complications (p < 0.05). By logistic regression, high age (OR 1.1; 95 % CI 1.0 - 1.2; p = 0.04) and high ASA classification (OR 6.7; 95 % CI 1.4 - 33; p = 0.02) predicted death, and high ASA classification predicted postoperative complications (OR 4.2; 95 % CI 1.7 - 10.2; p = 0.002). INTERPRETATION: Perforated peptic ulcer is a disease with low incidence, high mortality and a high frequency of postoperative complications, mainly determined by the patient's age and ASA classification.

Adult↗
PubMed2006

The "stamp method": a new treatment for perforated peptic ulcer?

BACKGROUND: The aim of this study was to develop a simple method for closure of a perforated peptic ulcer, making it more accessible for laparoscopic surgery. METHODS: An experimental pilot study was performed using five male Wistar rats. The perforation was closed by a bioabsorbable patch made of lactide-glycolid-caprolactone fixed with glue onto the outside of the stomach. RESULTS: Postoperatively, there were no signs of leakage or other complications. Histologically, there were no signs of inflammation on the inside of the stomach, and there was a 50% reduction of the perforation each successive postoperative week. No adverse reactions because of the degradable material or glue were observed. CONCLUSIONS: Treatment of a perforated peptic ulcer by placing a patch of biodegradable material like a "stamp" on the outside of the stomach is a feasible option.

Absorbable Implants↗