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PubMed1979

[The choice of operation in perforated gastroduodenal ulcer].

The main point for a surgeon treating a perforated peptic ulcer is to choose between a simple treatment of the complication and a treatment both of complication and ulcer disease. So, the A. have analysed their series of 58 patients with perforated peptic ulcer: one patient underwent nasogastric suction as suggested by Taylor, 16 patients underwent suture plication of the perforation, 41 underwent immediate gastrectomy. A fully follow-up was performed: in the suture-plication group only 28.5% was symptonfree, the remaining 71.5% had recurrent dyspepsia or underwent definitive gastrectomy. Follow-up results of the immediate gastrectomy patients and elective gastrectomy patients are the same. The A. discuss the different procedures of treatment and their specific indications. Surgical treatment is the selected one and simple suture and immediate gastrectomy are not opposite.

Gastrectomy↗
PubMed1979

[Perforations on peptic ulcers of the esophagus].

The term "atraumatic perforation of the oesophagus" which is suggested by ABBOTT covers several entities. HEBERER and RIOULT draw a distinction between spontaneous ruptures, which have their seat in a macroscopically healthy zone of the oesophagus, and perforations, which are the final consequence of a constant, progressive process of parietal erosion. Such a perforation may be due to complications of the peptic disease of the oesophagus. The transition from the perforating or intramural ulcer to the disintegration of the entire wall, with the formation of a mediastinal abscess, is progressive. The seriousness of the affection results from the perforation of this abscess into a neighbouring organ or cavity (mediastinum, lung, pericardium, pleura). In most cases, however, the perforation is closed by reactional mediastinitis, which also limits the seriousness of the phenomenon and permits a comparatively mild form of treatment (drainage).--Out of six cases of atraumatic perforation, we have observed two perforations on peptic oesophagitis: one of them exceptional, perforated into the aorta with immediate death, and the other perforated into the mediastinum and cured after resection of the oesophagus.

Adult↗
PubMed1989

All perforated ulcers are not alike.

To determine if ulcer location and other clinical factors affect the hospital course and early outcome of patients with perforated peptic ulcers in the decade since the introduction of H2 receptor antagonists, the records of 80 patients with perforated peptic ulcers were analyzed. Demographic factors, clinical features, and the outcome of patients with duodenal ulcer perforation were similar to patients with prepyloric ulcer perforation. In contrast, patients with gastric ulcer perforation had differing characteristics from the group with perforated pyloroduodenal ulcers. Overall, NSAID use preceded perforation in one half of the patients; severe coexisting medical illness and a short interval of symptoms before perforation were seen in more than one half of patients. Gastric ulcer location, hemodynamic instability, greater degree of peritoneal contamination, and larger ulcer size were factors associated with increased rates of mortality. Overall mortality rate was 12.5% and rate of morbidity was 33%. Oversewing with or without omental patch was the operation most commonly employed by a diverse group of surgeons.

Adult↗