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PubMed1953

Pneumoperitoneum in perforated peptic ulcer; factors in roentgenographic demonstration.

Evidence compiled in review of data on 324 cases of perforated gastric or duodenal ulcer indicated that pneumoperitoneum is more likely to be demonstrated in roentgen films made within six hours after perforation than in films made after a longer interval. In several cases films made early did not show intraperitoneal gas and later films did. There appeared to be no constant relationship between the size of the perforation and the incidence of demonstrable pneumoperitoneum. Pneumoperitoneum was less often demonstrated in cases of posterior perforation than it was when the lesion was at an anterior site. In many cases roentgen examination was performed with the patient in both the erect and the left lateral decubitus positions. These two roentgenographic views were equally reliable and there was agreement between them in 94 per cent of the cases. Clinical factors, however, may influence decision as to which position should be used in each case. Occasionally when intraperitoneal gas is not demonstrated in one view, it may be observed in films made with the patient in the other position.

Abdominal Injuries↗
PubMed1975

[Endoscopic diagnosis of masked perforated peptic ulcer].

Fifty eight patients hospitalized with a suspicion to masked perforated ulcer of the stomach and duodenum were subjected to urgent fibrogastroduodenoscopy by means of modern endoscopes with fiber optics. In 8 cases the perforation was diagnosed during endoscopy and subsequently supported intraoperatively. In the remaining patients the diagnosis of perforated ulcer was rejected. An application of urgent endoscopy in patients suspected of masked perforated gastric or duodenal ulcer made it possible to avoid useless laparotomies and shorten the terms of preoperative examination and determination of indications to surgical therapy.

Duodenal Ulcer↗
PubMed2005

Is there any role of acid reducing gastric surgery in peptic ulcer perforation?

Helicobacter pylori (H. pylori) is known to be the prime factor of peptic ulcer disease as well as NSAID usage. Although medical treatment of the bacteria can eliminate the problem for more than 90% of the infected people but the cost of treatment is high then acid reducing gastric surgery still has a definite role. The prevalence of H. pylori in peptic ulcer perferation is still unknown also whether vagotomy and gastrectomy could eradicate H. pylori. Now laparoscopic surgery especially the simple repair of the perforation has became routinely used in many part of the world. So acid reducing gastric surgery is a good choice in chronic user of NSAID and also an option for people who have H. pylori infection.

Digestive System Surgical Procedures↗
PubMed1993

Perforated peptic ulcer over 56 years. Time trends in patients and disease characteristics.

Perforated gastroduodenal ulcer was studied in 1483 patients in the Bergen area during the years 1935-90 to discover time trends in age and sex, disease characteristics, treatment, and outcome. The male:female ratio fell from 10:1 to 1.5:1, median age increased from 41 to 62 years. Most perforations were found in the duodenum in 1935-64, and in the pyloric and praepyloric area in 1965-90. There was a 10% occurrence of gastric ulcers throughout the study period. Ulcer site was related to age (more gastric and less duodenal perforations with increasing age) and sex (more pyloric and less duodenal ulcers among women). There were twice as many perforations in the evening compared with the early morning. The diurnal variation was more pronounced for duodenal and pyloric than for gastric and praepyloric perforations. Circadian and seasonal variation of ulcer perforation did not change during the 56 years studied. Treatment delay increased from median five hours to median nine hours. Infective complications and mortality fell with the introduction of antibiotics around 1950. General complications has increased in recent years because of the increase of elderly patients. Among patients who died, the proportion with associated disease rose from 27 to 85% during the study period.

Adult↗
PubMedDate not supplied

A simplified prognostic scoring system for peptic ulcer perforation in developing countries.

BACKGROUND: Several complex prognostic scoring systems are available for abdominal sepsis. We constructed and assessed a simplified scoring system for peptic perforation, which can be easily used in developing countries. METHODS: One hundred and forty consecutive patients with perforated pre-pyloric or duodenal ulcer undergoing Graham's patch omentopexy closure were studied prospectively. Each factor was given a score based on its severity in accordance with the APACHE-II scoring system to construct the simplified prognostic (Jabalpur) scoring system, and multiple regression analysis was used to identify risk factors. This system was prospectively validated in the next 50 consecutive patients and compared to existing systems. RESULTS: The factors associated with mortality were age, presence of co-morbid illness, perforation-to-operation interval, preoperative shock, heart rate, and serum creatinine. The mean score in survivors (4.9) was less than that in those who died (12.5; p<0.0001). This scoring system compared favorably with other scoring systems. CONCLUSIONS: The Jabalpur scoring system is effective for prognostication in cases of peptic perforation. It is simple and user-friendly as it uses only six routinely documented clinical risk factors.

APACHE↗