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At least 487 records · Page 27Linked to original sources
PubMed1999

Causes of death in patients with peptic ulcer perforation: a long-term follow-up study.

BACKGROUND: Survival is lower in ulcer perforation patients than in the general population. This study assesses the causes of death in patients treated for peptic ulcer perforation. METHODS: Cause-specific mortality in a population-based cohort of 817 patients treated for ulcer perforation in western Norway during the period 1962-1990 was compared with cause-specific population death rates. Analyses were based on observed and expected mortality curves for major causes of death and on standardized mortality rates (SMRs). Cox regression models were used to analyse possible differences on the basis of sex, birth cohort, surgical procedure, and ulcer location. RESULTS: Ulcer perforation patients experienced increased mortality from neoplasms (SMR = 1.8; 95% confidence interval (CI) = 1.4-2.1), lung cancer (SMR = 3.6; 95% CI = 2.3-4.9), circulatory diseases (SMR = 1.3; 95% CI = 1.1-1.6), ischaemic heart disease (SMR = 1.3; 95% CI = 1.03-1.6), and respiratory diseases (SMR = 1.9; 95% CI = 1.3-2.6). Postoperative deaths accounted for 38% of all excess deaths. Death from recurrent peptic ulcer was increased also in subjects who survived the 1st year after the perforation (SMR = 5.8; 95% CI = 1.2-10.4) but accounted for only a few deaths. The increase in mortality from lung cancer was higher in subjects born after 1910 than in patients of older generations. Excess mortality from lung cancer and from circulatory diseases was higher in male than in female patients. CONCLUSIONS: Increased mortality in ulcer perforation patients could mainly be attributed to smoking-related diseases. This is indirect evidence that smoking may be an important aetiologic factor for ulcer perforation.

Cardiovascular Diseases↗
PubMed1971

Perforated peptic ulcer in the Vancouver area: a survey of 852 cases.

A total of 852 perforations of peptic ulcers occurring in the Greater Vancouver area during the decade 1959-1968 have been studied. The incidence of perforation has declined during this period owing to a decrease in the number of perforations occurring in males. The incidence of perforation was similar to that in the South of England and New Zealand (approximately 10 per 100,000 population) but less than half that reported from Scotland.The sex ratio of 3.6 males to 1 female was similar to that found in other countries. The mean age of the males was 53.9 years and of the females 56.5 years. The peak incidence occurred in the decade 40 to 49 years. Patients with gastric perforations were significantly older than patients with pyloroduodenal perforations.Perforation occurred most frequently in the late afternoon, on Wednesday and during December; least commonly during the night, at the beginning of the week and through September.The pyloroduodenal was the commonest site of perforation (88%) and the usual treatment was simple closure (81%). The overall mortality rate was 18.3% and one-third of all fatalities were due to misdiagnosis. The operative mortality rate was 9%.

Adolescent↗
PubMed1994

Laparoscopic treatment of perforated peptic ulcer.

The technique of laparoscopic repair of perforated duodenal ulcers is described. Most patients have had a suture of the edge of the perforation and an omental patch. Laparoscopy allows a complete wash-out of the peritoneal cavity. There is no mortality. Early mobilisation and discharge from the hospital (5-8 days) are notable features. The possibility of simultaneous laparoscopic treatment of the perforation and the ulcer diathesis is discussed.

Duodenal Ulcer↗
PubMed1972

Aspirin ingestion and perforated peptic ulcer.

The results of a prospective inquiry into the aspirin taking habits of a consecutive series of 118 patients admitted to a large general hospital with acute perforation of peptic ulcer are presented. The series shows considerable increase in the proportion of females to males and of ulcers of the stomach compared to pyloro-duodenal perforations in contrast to British experience. Forty-five per cent of males and 75% of females were accustomed to taking at least two doses of an aspirin preparation weekly and most of the women took at least two doses daily. There was a highly significant association of heavy aspirin intake with ulcers of the stomach. The data support the theory that aspirin abuse is a cause of chronic gastric ulcer. It also supports the hypothesis that aspirin is the environmental factor responsible for the epidemic of gastric ulcers in middle-aged women in eastern Australia.

Aspirin↗
PubMed1994

[A rare symptom of peptic ulcer perforation: subcutaneous emphysema].

The authors describe a 50-year-old man who was hospitalized on account of one-week increasing epigastric pain with marked regression several hours after admission. The revealed small subcutaneous emphysema near the umbilicus directed the diagnostic procedure and led to detection of a covered perforation of a peptic prepyloric ulcer.

Humans↗
PubMed1999

Perforated peptic ulcer following gastric bypass for obesity.

Peptic ulcer in the excluded segment of a gastric bypass performed in the management of morbid obesity has only rarely been reported in the literature. The purpose of this study is to review our experience with the condition in a series of 4300 patients who underwent gastric-restrictive surgery between 1978 and 1997. Eleven patients presented with acute perforation of a peptic ulcer in the excluded gastric segment. Nine ulcers were duodenal, one was gastric, and one patient had both gastric and duodenal perforations. The time between primary gastric-restrictive surgery and ulcer perforation varied from 20 days to 12 years. All patients presented with upper abdominal pain. The classical radiological sign of perforated peptic ulcer, free air under the diaphragm, did not occur in any patient. Nine patients were initially treated by primary closure of the perforation with subsequent definitive ulcer therapy by vagotomy, pyloroplasty, or gastrectomy. One case, initially treated elsewhere, was managed by placement of a Malecot catheter through the duodenal perforation, gastrostomy, and peritoneal drainage. One recent case remains symptom-free on H2 blockers after simple closure. There was no mortality. Six cases were previously reported in the literature with a 33 per cent mortality rate.

Adult↗
PubMed1994

Case of perforated peptic ulcer treated conservatively.

We report a patient fifty-one-year old man with peptic ulcer which was treated conservatively. His chief complaints were epigastric discomfort and tarry stool. On admission, no fever was noted, the abdomen was flat and extremely hard, tenderness was noted, and peritoneal rebound was absent. Laboratory data on admission were all normal except for a slightly elevated CRP level. Oral intake was suspended and the patient received infusion. The chest X-ray film on the following day revealed free air, and the diagnosis of perforation of the upper digestive tract was confirmed; however, the symptoms and signs of peritonitis diminished. Therefore, he was treated conservatively. This case suggests that the conventional indications for emergency surgery for perforated peptic ulcer should be re-evaluated.

Anti-Ulcer Agents↗
PubMed1987

Non-steroidal anti-inflammatory drugs and hospital admission for perforated peptic ulcer.

The frequency of hospital admission for perforated ulcer was not measurably affected by concurrent use of non-steroidal anti-inflammatory drugs (NSAID) during nearly 30 million person-days of NSAID use at Group Health Cooperative of Puget Sound. Whether patients had ever used cimetidine or antacids, drugs which indicate the presence of ulcer disease or symptoms, was strongly predictive of perforation in the same population (rate ratio 5.1; 95% CI 2.6-10.0). Perforation rates increased sharply with age but were similar for men and women.

Adolescent↗
PubMed2005

Peptic ulcer perforation: management of high-risk cases by percutaneous abdominal drainage.

Sixty-six patients were selected as high-risk cases of duodenal ulcer perforation. After resuscitation with intravenous fluids and nasogastric suction, a widebore percutaneous intra-abdominal drain was put in under local anaesthesia. There were three (4.5%) deaths; 58 (87.8%) patients improved satisfactorily. High-risk peptic ulcer perforation patients can be managed by putting in an intra-abdominal drain supported by conservative treatment.

Adult↗
PubMed1986

Perforated peptic ulcer in south-eastern Nigeria 1973-1982.

In a prospective study aimed at evaluating a safe treatment for 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 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 haemorrhage in 10 patients (5.0%) and extensive scarring of the duodenum and pyloric stenosis in 9 patients (4.4%). In 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 show that simple suture is an adequate and safe treatment for perforated acute pyloroduodenal ulcer but this treatment is, however, followed by an unacceptably high mortality in patients with perforated chronic pyloroduodenal ulcers in whom were feasible, a definitive ulcer--curative surgery should be performed.

Adult↗