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PubMed2005

Perforated peptic ulcer treated by simple closure and Helicobacter pylori eradication.

Simple closure followed by Helicobacter pylori (Hp) eradication has become the most used procedure in perforated ulcer treatment. However, its efficacy and safety are still to be determined. To assess recurrence and re-perforation rates, and as a secondary objective, to analyze Hp infection rates in perforated ulcer patients and controls, we conducted a prospective study. Ninety-two consecutive patients (ages: 19-96 years) were operated on between 1996 and 2002, and treated by simple closure followed by Hp eradication and NSAID avoidance. The data were prospectively collected in a database. Hp infection was diagnosed in 68 patients (73.9%). Thirty-four patients (37%) consumed nonsteroidal anti-inflammatory drugs (NSAIDs), and 23 (25%) had both Hp infection and NSAID antecedents. The perforation was gastric in 4 cases and pre-pyloric, pyloric or duodenal in 88. There were postoperative complications in 24 patients (26%) and 4 patients died (4.3%). Hp eradication was shown in 46 patients. There was clinical ulcer recurrence in 4 (4.3%); in 3 of them recurrence manifested as re-perforation, all in gastric locations. Overall relapse and re-perforation 1-year crude rates were 6.1% and 4.1%, respectively. Crude rates for non-gastric ulcer recurrence were 0 at 1 year and 2.6% at 2 years and for non-gastric ulcer re-perforation rates were 0 at 1 and 2 years. This therapeutic strategy is associated with a low rate of recurrence and no re-perforations in case of duodenal, pyloric, or pre-pyloric perforated ulcers, but it is not acceptable for perforated gastric ulcers.

Adult↗
PubMed1975

[Additional diagnostic symptoms of perforated peptic ulcer].

Utilization of abdominal puncture after the author's technic and the analysis of pathological peritoneal content enabled the recognition of a number of signs typical for perforated gastroduodenal ulcer, which are described in this communication. Such conclusion was drawn based on the use of punctures in 167 patients and examination of the peritoneal exudate in 375 patients with different surgical affections of abdominal organs.

Adult↗
PubMed1988

Perforated peptic ulcer.

Peptic ulcer disease has declined significantly since 1950 in industrialized nations. However, the number of patients with perforated and bleeding ulcers has been constant or has declined only slightly, except for older patients, in whom the frequency has increased. In patients with perforated ulcers, operative management is preferable to non-operative treatment. The operative choices are simple closure of the perforation or definitive surgery. Patients who have significant risk factors should undergo simple closure. Closure of the ulcer with parietal cell vagotomy is the author's first choice for definitive operative treatment when this procedure can be performed.

Abdomen, Acute↗
PubMed1997

History of perforated duodenal and gastric ulcers.

Perforated peptic ulcer as a disease entity has been known since 167 BC. Surgical and nonsurgical treatment strategies for perforated peptic ulcer disease were not developed until the latter half of the nineteenth century. The history of the gradual evolution of the various forms of treatment adopted for the conditions over the last century and a half is described.

Duodenal Ulcer↗