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PubMedDate not supplied

[Laparoscopic approach in the treatment of perforated gastroduodenal ulcer].

The authors report on their experience with the treatment of 34 consecutive patients suffering from perforated peptic ulcer with peritonitis. All patients has been treated by the laparoscopic approach using sutures according to the Graham-Steele technique and omental plication. Irrigation, suction of the entire abdominal cavity with isotonic sodium chloride solution and drainage completed the procedure. In three cases, after an initial laparoscopic operation, we converted to laparotomy because of a large or unusually positioned ulcer. The morbidity rate was low and one patient died of myocardial infarction. The mean hospital stay was seven days. The method, which requires good laparoscopic experience, is simple, allows thorough toilette, has a low morbidity and is safe for the patient.

Adolescent↗
PubMed1992

Antiinflammatory drugs and emergency surgery for peptic ulcers in the Waikato.

OBJECTIVE: to examine the use of antiinflammatory drugs in patients undergoing emergency surgery for bleeding and perforated peptic ulcers in the Waikato. METHODS: a retrospective case control study of all patients who had emergency surgery for bleeding and perforated peptic ulcers at the Waikato Hospital from March 1987 to March 1991. RESULTS: seventy-seven patients underwent emergency surgery for complicated peptic ulcers over the study period. Forty-six (60%) of these patients were taking antiinflammatory agents at the time of admission to hospital. In an age and sex matched group of patients undergoing nonulcer emergency surgery over the same period 18 of 77 patients (23%) were using antiinflammatory drugs (p less than 0.001). There was no difference in the postoperative morbidity or mortality between the antiinflammatory drug takers and the nondrug takers following emergency ulcer surgery. CONCLUSIONS: the findings confirm the high level of use of antiinflammatory drugs by patients who require emergency surgery for life threatening complications of peptic ulcers. Patients taking aspirin, nonaspirin nonsteroidal antiinflammatory drugs (NNSAIDs) and oral steroids form a major part of the workload in the emergency surgical treatment of bleeding and perforated peptic ulcers.

Age Factors↗
PubMedDate not supplied

[Perforated ulcer in Meckel's diverticulum].

Three cases, two women and one man, aged 27, 47 and 79 years with perforated peptic ulcer of Meckel's diverticulum are reported. All patients had diffuse peritonitis. The exact diagnosis of the cause of peritonitis has not been preoperatively established in any of them. In two patients cuneiform excision (diverticulectomy) was performed, and resection and anastomosis of the small intestine in the third. The female patients, aged 79, after an uneventful recovery suddenly died due to an acute heart failure on the eight day after surgery. In other patient suppuration of the wound occurred and convalescence was prolonged. In all cases microscopic examination revealed ectopic gastric mucosa on the top of the diverticulum with peptic ulcer.

Adult↗
PubMedDate not supplied

Taylor's method: a therapeutic alternative for perforated gastroduodenal ulcer.

BACKGROUND/AIMS: In the context of actual trends towards an efficient and less aggressive therapy of peptic ulcer, it seems that Taylor's method, in selected cases of perforated gastroduodenal ulcers (PGDU), comes again into attention. The aim of this study was to present our 16 years' experience with Taylor's treatment as an efficient option for sealed perforated ulcers, and to highlight the indications and advantages of this method. METHODOLOGY: A retrospective study, and prospective since 1990, was carried out on a series of 64 patients out of 592 (10%) diagnosed with PGDU between 1987 and 2003. The patients were carefully evaluated, particularly looking for clinical, laboratory and imaging diagnosis factors, indicating potential candidates for conservative approach: short history, hydropneumoperitoneum in small amount on admission. Two thirds of the patients presented in the Emergency Unit less than 12 hours from the onset of the symptoms. The diagnosis of PGDU was established by corroborating the obvious symptoms and abdominal signs with erect chest X-ray and ultrasonography (US) of the abdomen. The efficiency of Taylor's method, consisting of nasogastric aspiration, fluids resuscitation, parenteral broad spectrum antibiotics and antisecretory drugs, was assessed by meticulous repeated physical examinations, dynamics of WBC (white blood cell) and US. In case of failure, this method remained as a part of preoperative treatment. RESULTS: The method was successful in 57 out of 64 (89%) cases of perforated peptic ulcer disease, selected from the 592 cases admitted with perforated peptic ulcer following the clinical and imaging criteria previously mentioned. The presence of pneumoperitoneum certifies the diagnosis of PGDU, but the amount of peritoneal fluid assessed by US predicts the success of the procedure. Seven patients developed complications (10.9%), mainly intraabdominal abscesses and only four of them needed surgical drainage. The mortality was nil. After discharge all patients were referred to gastroenterologists for monitoring the medical treatment and no recurrence was encountered. CONCLUSIONS: The Taylor's method is a reliable alternative in selected cases of perforated gastroduodenal ulcers, the main advantage being the avoidance of anesthetic and surgical stress with their potential morbidity and mortality.

Adolescent↗
PubMed2001

[Perforated ulcer].

BACKGROUND: We wanted to review patients operated for perforated peptic ulcer at Ullevål University Hospital, Oslo, Norway in the period 1992-1997. MATERIAL AND METHODS: Data from 84 operated patients (43 men) were obtained retrospectively from patient and hospital files. Median age was 69 years (range 20-92 years). RESULTS: 41 patients had perforated duodenal ulcer and 43 had perforated gastric ulcer (pylorus included). Median time from start of symptoms until admission to hospital was 5 hours (range 2-24 hours; n = 40) and from admission to start of surgery 5 hours (range 1 1/2-48 hours; n = 69). 64 out of 74 patients had pneumoperitoneum on preoperative abdominal X-ray examination. 77 patients were operated with rafi and/or tegmentation of the perforation; six patients with Billroth II or Billroth I; one patient was treated with percutaneous drainage. Median duration of surgery was 68 minutes (range 40-240 minutes). Thirteen patients died in hospital. Post-operative complications were recorded in 30 patients. INTERPRETATION: Early surgical intervention is important to reduce lethality from ulcus perforatum. A patient with clinical peritonitis and suspected perforated peptic ulcer should be operated without time-consuming examinations.

Adult↗
PubMed1992

[Laparoscopic closure and tegmentation of perforated ulcer].

Laparoscopy is fully recognized for diagnosis and even treatment of various acute abdominal conditions. In a 42-year-old woman with intense lower abdominal pain, laparoscopy revealed a perforated peptic ulcer. The ulcer was closed and patched with omentum and the abdomen was irrigated, all by laparoscopic techniques. Except for a minor wound infection recovery was uneventful.

Abdomen, Acute↗
PubMed1994

[Treatment of perforated duodenal ulcer: the celioscopic approach].

Ten patients underwent laparoscopic surgery for typical perforated peptic ulcer symptomatology. Two conversions to open surgery were due to technical problems related to delayed hospital admission. Nine patients underwent duodenal suture reinforced with fibrin glue, and one perforation was only glued. The postoperative course was uneventful without abdominal septic or abdominal wall complications in the eight patients treated by laparoscopy. Laparoscopic surgery may become the method of choice for the treatment of perforated peptic ulcer.

Adult↗