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PubMed1990

[Cellular immunity in peritonitis caused by appendicitis and peptic ulcer perforation].

In examination of 26 patients with peritonitis caused by appendicitis and ulcer perforation, the suppression of T-cellular immunity, which grew with the progression of a pathological process, was established. In perforative peritonitis, the more rapid and deep, as compared with appendicular peritonitis, suppression of the T-system of the immunity was noted.

Acute Disease↗
PubMed1979

[Diffuse peritonitis caused by peptic ulcer perforation in patients previously gastrectomized].

The Authors have collected during 28 years 26 cases of acute perforation, in free peritoneum, of gastrojejune ulcers in subjects who, in precedent times, had been operated for gastro-duodenal ulcer. In 24 cases the rafia has been practised, with 5 deceased: in two cases immediate resection has been practised, with two recoveries. The Authors do some considerations about the aetiopathogenesis of peptic post-resection ulcer and about its perforative complication, and also about the urgent surgical therapy that, except exceptional cases for special anatomic-pathological conditions, must be limited to the simple rafia, referring to futher time radical gastro-jejune-resection.

Gastrectomy↗
PubMed2001

[Conventional surgery in peptic ulcer perforation: indications and procedure].

Open surgery of ulcer perforation still represents the treatment of choice in 2001. This procedure allows a safe approach to the ulcer site and exact excision of the border of the ulcer in order to reach tissue with good vascularisation. In pre-, intra- and post pyloric ulcer perforation the gastric outlet can be palpated after suturing in order to avoid stenosis. In gastric outlet obstruction or large perforated ulcers gastric resection can be performed. Open surgery allows an exact lavage of all quadrants of the abdomen in order to remove all sequelae of peritonitis. According to the current study laparoscopic procedures have no advantages compared to open surgery for ulcer perforation. Conservative treatment includes the risk of safety of diagnosis and difficulties in the continuous clinical monitoring as well as significant disadvantages in case of delayed laparotomy.

Duodenal Ulcer↗
PubMed1996

Survival after peptic ulcer perforation: a time trend analysis.

The survival of 1098 patients with ulcer perforation in Norway during the period 1952-1990 was compared with expected survival. Cox regression models incorporating population mortality rates, were used to analyse effects of sex, age, year of birth, and year at risk on excess mortality. Survival was lower in patients than in the general population through a follow-up period of 38 years. Relative survival was lower in women as compared to men, due to more delayed treatment. Long-term survival was lower after praepyloric perforations than after the other perforation types. Relative survival was higher in patients treated 1952-1970 than in those treated more recently. However, adjustment for year of birth revealed a decline in short-term mortality with calendar time, which is in accordance with improved management during the study period. Relative mortality, particularly long-term mortality, was higher in younger birth cohorts, suggesting a shift towards more serious etiologies.

Cohort Effect↗
PubMed1986

Proximal gastric vagotomy in emergency peptic ulcer perforation.

In order to evaluate proximal gastric vagotomy (PGV) performed under different clinical conditions, we compared the late results of 93 patients who underwent emergency PGV for perforated duodenal ulcers with those of 60 patients who had elective PGV. The emergency group of patients were slightly younger and there was a higher male predominance but they were otherwise comparable with those in the elective group. There were no operative deaths and the postoperative morbidity rate was low in both groups. Three patients had a recurrence in the emergency group, and seven occurred in those in the elective group during the first three postoperative years. The cumulative recurrence-free rate of the emergency group was not lower than that of the elective group. The performance of the individual surgeon exerted a strong influence on the incidence of recurrent ulceration. In properly selected patients, whether the surgeons perform PGV in emergency or elective situations appears to have little influence on the outcome.

Adult↗
PubMed1998

Density of Helicobacter pylori infection in patients with peptic ulcer perforation.

BACKGROUND: A lack of change in prevalence of severe ulcer complications requiring emergency operation has been reported, despite the common use of histamine-2 (H2)-receptor antagonists and proton pump inhibitors. This may be attributable to use of ulcerogenic drugs or Helicobacter pylori (HP) infection, or both. In this study, HP infection was evaluated semiquantitatively in patients with peptic ulcer who required surgery, and the severity of histologic change was investigated. METHODS: We reviewed a total of 113 consecutive patients (98 men and 15 women) operated on for perforation, hemorrhage, or stenosis of gastroduodenal ulcer between January 1986 and December 1995. Detection of HP was carried out by immunohistochemical staining. We graded the density of HP infection according to the number of individual HP bacteria counted in a highly magnified visual field (x 1,000 of light microscopy). The grade of HP infection was defined as follows: (0) = 0; (1+) = 1-9; (2+) = 10-29; (3+) = 30-99; (4+) > or = 100. The severity of gastritis was evaluated by histologic examination using the criteria of Rauws. RESULTS: Although the number of operations for gastroduodenal ulcer declined significantly, the rate of emergency operation for gastroduodenal ulcer increased from 60% to 90%, with the result that the frequency of operations for perforation or bleeding remained virtually constant and that for stenosis significantly decreased. HP infection was more prevalent in perforated ulcer (92%) than hemorrhagic ulcer (55%) or stenotic ulcer (45%). The grades of HP infection were 3.0 +/- 0.14 (mean +/- SEM) in perforated ulcer, 2.3 +/- 0.34 in hemorrhagic ulcer, and 2.5 +/- 0.22 in stenotic ulcer. Perforated ulcer was associated with significantly more severe HP infection and gastritis changes than hemorrhagic ulcer or stenotic ulcer. CONCLUSIONS: This study indicates that patients with perforated ulcer were infected with HP more severely than those with hemorrhagic ulcer or stenotic ulcer at the time of surgery. A close relationship was observed between the perforated ulcer and the density of HP infection determined semiquantitatively using immunohistochemical stain.

Adolescent↗
PubMed1980

Pericardial complications of peptic ulceration.

Intrathoracic perforated peptic ulceration is uncommon. Two patients are reported with pericardial fistulization secondary to peptic ulceration. These occurred following colonic bypass surgery as a consequence of peptic esophagitis and hiatus hernia.

Adolescent↗