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At least 343 records · Page 19Linked to original sources
PubMed1981

Perforated peptic ulcer in the elderly.

From 1973 through 1979, 32 patients over 60 years of age were admitted to the Beth Israel Medical Center, New York, because of a perforated gastric or duodenal ulcer. In many of them, the symptoms and physical findings were minimal. In abdominal roentgenograms (subject erect or supine), only 17 (60 percent) of these patients showed free intraperitoneal air. Among the 29 surgically treated patients, plication of the ulcer was performed in 28 and hemigastrectomy-vagotomy in one. The postoperative morbidity rate was 62 percent, and the mortality rate 17 percent. In 3 of the 32 patients, the diagnosis of perforated ulcer was established only at autopsy. Thus, failure to diagnose this condition accurately may be the principal cause of death in elderly patients with a perforated peptic ulcer. The increased use is recommended of contrast roentgenograms of the stomach and duodenum and of endoscopy, in an effort to improve diagnostic accuracy in dealing with perforated peptic ulcers.

Aged↗
PubMedDate not supplied

Perforated peptic ulcer--time trends and patterns over 20 years.

There are contradictory reports in current world literature regarding incidence of perforated peptic ulcers and male to female ratio in recent years. Old concepts of seasonal periodicity are being questioned. In our report we analyze what is changing with regard to demographical data of patients affected, incidence of perforation of peptic ulcer and ulcer location. This article reviews 441 consecutive cases of this complication of peptic ulcer disease (PUD) treated in our department between January of 1977 and December of 1996. The source of analyzed data are operative reports. Several observations regarding number, age and sex of patients affected and ulcer location have been made.

Adolescent↗
PubMed1994

Laparoscopic Repair of Perforated Peptic Ulcer.

The recent introduction of laparoscopy into the armamentarium of the general surgeon has revolutionized many aspects of surgical practice. The repair of perforated peptic ulceration is ideally suited to a laparoscopic approach. An accurate diagnosis is obtained, and closure of the perforation with thorough peritoneal toilet safely can be undertaken. The main advantages include the avoidance of a major incision and the reduction of postoperative pain. This may benefit the patient with associated respiratory disease in particular. Although mobilization may be improved, early discharge from the hospital is unlikely because the patient must recover from the peritonitis and associated ileus. The main drawback is a longer operating time caused by technical difficulty with laparoscopic suturing. Many innovative techniques have been described to simplify the procedure. The reported experience with laparoscopic repair of perforated peptic ulcers is encouraging, and randomized trials comparing it with open surgery are eagerly awaited.

Journal Article↗
PubMed2003

Significance of intraoperative peritoneal culture of fungus in perforated peptic ulcer.

BACKGROUND: The incidence of postoperative fungal infection is increasing and the gastrointestinal tract is the major source, but antifungal therapy in perforated peptic ulcer (PPU) is still controversial. The aim of this study was to determine the significance of intraoperative peritoneal fluid culture of fungus and establish the indications for treatment. METHODS: Between July 1997 and September 2001, all patients admitted with a PPU were studied. Clinical data and peritoneal fluid for culture were collected. Risk factors for a positive peritoneal fluid culture of fungus and outcome were evaluated, and related to the development of surgical site infection, duration of hospital stay and mortality rate. RESULTS: One hundred and forty-five patients with a PPU were included; 63 (43.4 per cent) had positive peritoneal fluid fungal culture. Age, preoperative organ failure, delay in operation, high Mannheim Peritonitis Index (MPI) and Acute Physiology And Chronic Health Evaluation (APACHE) II scores, and preoperative antibiotic therapy were risk factors for a positive fungal culture. Sex and an MPI score of 20 or more remained significant in multivariate analysis (P < 0.001). Patients with a positive fungal culture had a higher incidence of surgical site infection, a longer hospital stay and a significantly higher mortality rate, especially when this was combined with a high MPI score. CONCLUSION: Positive peritoneal fungal culture was common and was a significant risk factor for adverse outcome in patients with a PPU. A high MPI score could be used as an indicator for prophylactic antifungal therapy.

APACHE↗
PubMedDate not supplied

Statistical analysis in the differentiation between cases of serious acute pancreatitis and generalized peritonitis due to a perforated peptic ulcer.

Serious acute pancreatitis was considered by the authors as one of the diseases which must be distinguished from generalized peritonitis due to perforated peptic ulcer. An attempt was made to differentiate between these two conditions without reference to two factors, namely amylase value and intraperitoneal free air. Differential diagnosis by linear discriminant analysis, making full use of information such as the history of the present illness, general and abdominal findings and laboratory data, was undertaken. This resulted in a satisfactory predictive value, at least for sample cases. Lastly, items which seem to be important for differentiation between the diseases are discussed.

Acute Disease↗