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PubMed1987

Peptic ulcer perforation associated with steroid use.

A ten-year (1974 to 1984) retrospective chart review was conducted to find all patients with peptic ulcer perforation associated with steroid treatment. During this period, 151 peptic ulcer perforations occurred, 25 (17%) associated with steroid use. Twenty patients had the diagnosis confirmed at operation, five at autopsy. The most common operative procedure was oversewing of the perforation with an omental patch (ten cases). Postoperative complications occurred in 16 patients and were multiple in 11. Underlying malignant neoplasms were the most common concurrent disease (11 patients), five patients having brain metastasis. Of 25 patients, 15 died--five preoperatively and ten postoperatively. Patients older than age 50 years had an overall mortality of 85%; those younger than age 50 years, 17%. A recurring pattern in 21 patients was perforation occurring after a major increase in steroid dose (pulse). Ulcer perforations associated with steroid use constitute a significant portion of all ulcer perforations, are lethal in most patients older than age 50 years, and are often associated with a steroid pulse before perforation.

Female↗
PubMed2000

Trends in perforated peptic ulcer: incidence, etiology, treatment, and prognosis.

After increasing steeply at the beginning of the twentieth century, ulcer perforation incidence during the last decades has declined in the young and in men, and it has risen among the elderly and in women. These changes can be attributed to a cohort phenomenon: Ulcer perforation risk is particularly common in the cohorts born after the turn of the twentieth century and is less common in previous and succeeding birth cohorts. A decline in total incidence is expected with the death of the high risk cohorts. Most ulcer perforations among subjects < 75 years of age can be attributed to smoking. Subjects with a history of ulcer perforation therefore have poorer long-term survival than the general population, most pronounced for younger generations. About one of four ulcer perforations can be attributed to the use of nonsteroidal antiinflammatory drugs, a risk factor of particular importance in the elderly. Ulcer perforation was frequently treated by gastric resection in former days, whereas suture, being the first method introduced in 1887, is the method of choice today. The introduction of antibiotics improved the prognosis of ulcer perforation surgery greatly. Postoperative lethality decreased until 1950 but has remained stable since then. Lethality is higher in the elderly and is higher after gastric than after duodenal perforation. The delay before surgical treatment is a strong determinant for lethality, complication rates, and hospital costs. Treatment delay seems to have increased during the last

Age Factors↗
PubMed1981

Simple closure of perforated peptic ulcer. Still an effective procedure for patients with delay in treatment.

Sixty patients (mean age, 50 years) underwent simple closure of a perforated peptic ulcer. For 56 patients, average delay in treatment was 21.6 hours. Postoperatively, 21 patients (treatment delay, 30 hours) had either pulmonary or abdominal complications. Ten patients (treatment delay, 34 hours) died. Acute onset of ulcer symptoms prior to perforation was associated with a threefold increase in mortality compared with patients with chronic symptoms. Seven patients subsequently underwent vagotomy and partial gastrectomy without complications. This study demonstrates that in patients with peptic ulcer disease, perforation is an unusually frequent indication for operation; advanced age, treatment delay of 30 hours or more, and acute ulcer symptoms are associated with increased morbidity and mortality; and simple closure of the perforation remains an effective procedure in patients who have delayed seeking treatment.

Adolescent↗
PubMed1992

Perforated peptic ulcer--the changing scene.

There is a changing scene with perforated peptic ulcer. The older age of presentation, the increased association with non-steroidal anti-inflammatory drugs, associated increased debility, and resulting higher mortality in the elderly, are causing a rethink in management protocols. Whereas years ago most discussion was on whether urgent definitive surgery was the most effective therapy, nowadays there is a tendency to less invasive measures. A 'deliberative' approach, wherein not all patients require surgery, is detailed, and there may be an increasing role for laparoscopic perforation-sealing techniques in the remainder. Anti-secretory and anti-helicobacter drugs have an important role in post-operative care following lesser procedures than definitive surgery.

Adult↗
PubMed2001

Selection of patients for laparoscopic repair of perforated peptic ulcer.

BACKGROUND: Although randomized and non-randomized studies have evaluated the safety of laparoscopic repair for perforated peptic ulcer, no definite guidelines have been published on selection of patients for laparoscopic repair. This cohort study aimed to define patients who may not benefit from laparoscopic techniques. METHODS: The data from 374 consecutive patients with perforated peptic ulcer treated by simple repair were collected prospectively and analysed. RESULTS: From January 1992 to December 1998, 219 patients were treated by open suture repair, 109 by laparoscopic sutureless (fibrin glue) repair and 46 by laparoscopic suture repair. The overall leak rate after laparoscopic suture and sutureless repair was 6 and 16 per cent respectively. Leakage was noted to be associated with a significantly higher rate of wound infection, intra-abdominal abscess formation, prolonged ileus (P < 0.001) and longer hospital stay (11 versus 5 days; P < 0.001). Multivariate analysis demonstrated that Acute Physiology and Chronic Health Evaluation (APACHE) II score on admission predicted the likelihood of a leak after laparoscopic fibrin glue repair (P = 0.006). CONCLUSION: APACHE II score may be a useful index for selecting patients for laparoscopic fibrin glue repair.

APACHE↗
PubMed1993

[Perforated peptic ulcer in patients with central nervous system injury].

There were 10 cases of perforated peptic ulcer (PPU) occurring in patients with central nervous system injury from July 1982 to December 1991; 7 cases occurred in intensive care unit whereas 3 cases occurred in the ordinary ward. Because of inability of these patients to express abdominal pain, the diagnosis of PPU was suspected only in the presence of the frequently associated clinical signs such as abdominal distension, fever, tachypnea, tachycardia, and hypotension. Because the diagnosis of PPU in these patients is generally delayed, mortality up to 60% is noted. The diagnosis of PPU was made by chest X-ray with pneumoperitoneum in only 5 of the 10 patients, whereas that of the remaining 5 patients was made by peritoneal lavage with bile-like ascites. There is a good correlation between the presence of shock after PPU and the survival of the patients. We recommend that once there are abnormal abdominal signs, inexplicable hemodynamic changes in patients with central nervous system injury, immediate thorough examination in search of PPU should be made to detect early the life-threatening PPU and to reduce the mortality thereafter.

Adolescent↗
PubMed1996

Laparoscopic suture closure of perforated peptic ulcer. A nonrandomized comparison with open surgery.

BACKGROUND: Laparoscopic vs open suture in the surgical treatment of perforated peptic ulcer were compared in a retrospective study. METHODS: The outcome of 10 patients having the laparoscopic procedure was compared with the outcome of 17 patients treated with suture via laparotomy during the same time period. RESULTS: The mortality rate and the complication rate were comparable. The laparoscopic procedure was more time consuming; hospital stay did not differ. CONCLUSIONS: The results indicate that surgery for perforated peptic ulcer can be performed with the laparoscopic technique with an outcome comparable to open surgery. No obvious advantages to the patient were noted with the laparoscopic method.

Aged↗
PubMed1995

Laparoscopic repair of perforated peptic ulcer.

A total of 100 consecutive patients with perforated duodenal or juxtapyloric ulcers were treated by: laparotomy and omental patch repair (group 1, n = 44); laparoscopic suture patch repair (group 2, n = 35); and laparoscopic fibrin glue repair (group 3, n = 21). The three groups were comparable in Acute Physiology And Chronic Health Evaluation II score and in other known operative risk factors such as shock on admission, delayed presentation and associated underlying medical illness. Operative mortality and morbidity data were identical in all groups. The mean operating time was 52.1, 101.3 and 61.1 min respectively in the three groups (group 1 versus group 2, group 2 versus group 3, and group 1 versus groups 2 and 3 combined, P < 0.001). The median number of doses of analgesia required after operation was 4, 3 and 1 respectively (group 1 versus groups 2 and 3, P < 0.05). Conversion to laparotomy was necessary in six patients in group 2 and in one in group 3 (P not significant). The median hospital stay was 5 days in all three groups. Patients who underwent laparoscopic repair of perforated peptic ulcer required fewer postoperative doses of analgesia than those who had open repair. Laparoscopic glue repair has the additional advantage over laparoscopic suture of being technically simpler; it also takes less time to perform.

Aged↗
PubMedDate not supplied

[Surgical treatment of perforated gastric ulcer].

INTRODUCTION: Peptic ulcer perforation is a complication of ulcer disease which requires urgent surgical treatment. The aim of this paper was to point out our experience in surgical treatment of perforated peptic ulcer. MATERIAL AND METHODS: This retrospective study analyzes results of surgical treatment in 365 patients with perforated peptic ulcer during the period January 1996 to December 2000. RESULTS: During the last 5-year period 365 patients were treated following peptic ulcer perforation. The average age was 43.53 +/- 8.26, with the span from 18 to 86. The most frequent surgical procedures in treatment of peptic ulcer perforation were: simple closure with biopsy (55.88%), excision of the ulcer with a pyloroplasty and vagotomy (35.29%) as nonresection surgical procedures and stomach resection after Billroth II (8.83%). The postoperative mortality was 4.41%. CONCLUSIONS: The methods of choice in surgical treatment of gastric ulcer perforation are nonresection surgical procedures with drug therapy and eradication of Helicobacter pylori, if present.

Adolescent↗
PubMed1984

What has happened to perforated peptic ulcer?

The number of elective operations for chronic peptic ulceration has decreased substantially with the widespread use of H2-receptor antagonists. We have reviewed all cases of perforated peptic ulcer in Oxford over the last 18 years (1965-82) to see if a similar change in the incidence of this major complication of peptic ulceration has occurred. Since 1976 there has been a fall in the incidence of perforated peptic ulcer from 8.7 to 6.9 cases per 100 000 population per year. The male to female ratio decreased over the review period from 4.9:1 to 1.9:1 owing to a reduced incidence of perforation in men and an increased incidence in women. The mean age of men with perforated duodenal ulcer increased from 52.3 years in 1965-70 to 59.0 years in 1977-82. One hundred and sixty-six patients treated between 1977 and 1982 have been reviewed in detail. The overall mortality in this 6 year period was 12.7 per cent with an operative mortality rate of 8.9 per cent. The majority of perforations (65 per cent) are now of acute ulcers and therefore are unlikely to be prevented by improved therapy for chronic peptic ulceration.

Aged↗
PubMedDate not supplied

Evaluation of risk factors for mortality in surgically treated perforated peptic ulcer.

BACKGROUND/AIMS: The aim of our study was to evaluate complications and possible risk factors for mortality in perforated peptic ulcer patients with a special reference to the fact whether definitive or non-definitive operation was performed. METHODOLOGY: All 394 patients (mean age: 45.5 years; range: 15-93) from Tartu county hospitalized for PPU at Tartu University Clinic in the period 1978-97 were included in a retrospective study. RESULTS: Twenty-two patients (5.6%) of 394 died. In 73 patients 93 concomitant diseases (mortality 19.2%) and in 81 patients 114 complications were observed. There were 245 non-definitive operations and 141 definitive operations with a mortality rate of 7.3% and 1.4%, respectively. Univariate logistic regression analysis of 386 operatively treated patients revealed that age > or = 65 years, concomitant diseases, treatment delay > or = 12 hours, female sex and non-definitive operations were significantly associated with mortality. However, multivariate analysis showed that only age > or = 65 years and concomitant diseases were independent predictors of mortality. CONCLUSIONS: Patients' high age and presence of concomitant diseases were related to lethal outcome after surgical procedure performed for perforated peptic ulcer. The result did not depend on the fact whether definitive or non-definitive operation was applied.

Adolescent↗