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Results for “PEPTIC ULCER PERFORATION”

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PubMedDate not supplied

[Acute surgical pathology in elderly patients].

The consequence of demographic aging is an increase of surgical pathology of the elderly, concerning both number and complexity of the cases. To asses the nature of geriatric surgical pathology and the effect of co-morbidities on surgical outcome, a retrospective study was carried out on a series of 401 patients aged over 75, treated in the IIIrd Surgical Unit in the period 2002-2003. 132 patients were admitted as acute cases and 94 of them were operated: 62 required immediate surgery and 32 required delayed operations. According to the nature of the diseases, benign surgical conditions were encountered in majority of the cases (78 cases). The diagnostics requiring immediate operations were: complicated hernias, perforated peptic ulcer, lower limb acute ischemia. Delayed emergency operations were performed for: acute cholecystitis, biliary lithiasis with angiocholitis and complicated gastric cancer. Cardiovascular pathology was recorded as the most frequent co-morbidity. Hospital mortality rate of 32.9% resulted mainly from cases with mesenteric infarction and generalized peritonitis, as well as from delayed emergencies such as complicated gastric and colon cancer. The most frequent causes of death following surgery were: cardiac failure, sepsis and multiple organ failure.

Abdomen, Acute↗
PubMed2006

Suxamethonium-induced hyperkalaemia in a patient with a normal potassium level before rapid-sequence intubation.

The use of suxamethonium (succinylcholine) for rapid-sequence intubation may be limited by hyperkalaemia. Modest pre-induction hyperkalaemia is usually disregarded. We present a patient who underwent emergency surgery for a perforated peptic ulcer after being bedbound for 26 days because of a head injury. Serum potassium level was 4.0 mmol/L. The patient was intubated after injection of sedative and suxamethonium and, about 3 minutes later, developed ventricular arrhythmia. Blood tests during resuscitation showed a serum potassium level of 8.8 mmol/L. Immobilisation, denervation and intra-abdominal infection were risk factors for hyperkalaemia in this patient. This report reinforces the need to identify risk factors for hyperkalaemia before administration of suxamethonium, even when serum potassium levels are normal.

Aged↗
PubMedDate not supplied

[Effect of H2 blockers on the surgical indications for peptic ulcer].

The effects of introduction of cimetidine therapy were studied by an analysis of all cases of peptic ulcer who came to be operated at the Hospital das Clinicas of the University of São Paulo in the period between 1966 and 1985. A reduction in the frequency of surgical interventions especially after 1978, was verified. Ten percent of all cases operated between 1973 and 1985 and chosen at random were studied in a more detailed way. A reduction in the number of operations for gastric and duodenal ulcers was found. There was a greater interval between diagnosis and surgery, an increased number of operations for stenosis and hemorrhagic peptic ulcers and a reduction in frequency of operations for perforated peptic ulcer. There were no significant differences as to the sex and age of patients, except in cases of perforated peptic ulcer, with a larger number of female patients.

Analysis of Variance↗
PubMed1995

Atypical presentation in the elderly--case report of an acute abdomen.

An elderly woman with an acute abdomen due to a perforated peptic ulcer is discussed to illustrate the problem of atypical presentation of illness in the elderly. The importance of not dismissing non-specific symptoms and signs such as confusion, restlessness, abdominal distention and non-localising abdominal tenderness in the elderly, is highlighted. In addition, the useful radiological features of pneumoperitoneum are described. The need for functional assessment and rehabilitation are emphasised as important components in the practice of geriatric medicine.

Abdomen, Acute↗
PubMed1993

Gastrointestinal complications after cardiac surgery.

Gastrointestinal complications after cardiac surgery are uncommon, but are associated with a high morbidity and mortality. Over 11 years 8559 procedures requiring cardiopulmonary bypass were performed in this unit and 35 patients were identified who developed gastrointestinal complications after surgery, an incidence of 0.41%. There were nine deaths in this group, a mortality of 25.7% compared with an overall mortality after cardiac surgery in Ireland ranging from 3.24% to 4.81%. These complications required surgery in 21 patients. The most common indication for surgical intervention was upper gastrointestinal bleeding in 10 patients, three patients had acute pancreatitis, two patients had perforated peptic ulcer; two patients had intestinal ischaemia, with five cases of colon pathology. The difficulties of making an early diagnosis are outlined and a low threshold to exploratory laparotomy is recommended.

Adolescent↗
PubMed1996

[Emergency laparoscopic surgery].

The acute abdomen continues to be a large part of the general surgeon's workload. The continuing advances in laparoscopic surgery have already permitted many emergency procedures to be performed by this route. Since 1993 the Authors perform an explorative laparoscopy in patients with acute abdomen. Once the diagnosis is verified, the endoscopic view suggests to continue the intervention laparoscopically or to convert the procedure. 70 acute cholecystitis, 57 acute appendicitis, 15 perforated peptic ulcers, 6 gynaecological emergencies, 8 intestinal occlusions and 2 splenic traumas were treated according to this approach. The results obtained testify that laparoscopy is a valuable diagnostic tool for the surgeon in case of acute abdomen and an interesting therapeutic alternative in selected cases. However, it requires extensive experience in laparoscopic techniques.

Abdomen, Acute↗
PubMed1998

[Status febrilis and jaundice].

A 49 year old patient was admitted with fever and jaundice. Laboratory evaluation showed leukocytosis, elevated values for C-reactive protein, transaminases, bilirubin and alkaline phosphatase. Ultrasound and subsequent CT-scan revealed multiple liver lesions and a liquid mass in the bursa omentalis. A CT-guided catheter-drainage was performed and streptococcus milleri isolated from the abscess and one blood culture. After empiric broad spectrum treatment with Piperacillin/Tazobactam (Tazobac) and Netilmicin (Netromycin), Ceftriaxon (Rocephin) was given for a total treatment time of 10 days. Further evaluation revealed a perforated peptic ulcer as possible etiology for the described localized infectious complication.

Abdominal Abscess↗
PubMed1980

[Emergency or deferred treatment of perforated and bleeding gastroduodenal ulcer].

The treatment of perforated peptic ulcer, according to the experience of the Authors (327 cases), must be very pressing and always surgical. The closure of the perforation, the simplest treatment, seems the most suitable and the least dangerous for the survival of the patient, even though 68% of these patients will have to undergo surgery again in the course of 10 years. The radical treatment of resection, is reserved to few and carefully chosen cases, because it is loaded with sufficient risk. Acute bleeding peptic ulcer (86 cases) requires the operation: immediate or delayed according to the importance of the hemorrage: very serious, serious, moderate.

Emergencies↗
PubMed1990

[Long-term study of gastroduodenal ulcer perforation].

One hundred forty-four patients, peptic (129 males and 15 females) treated for peptic ulcer perforation between 1972 and 1988 were reviewed. All were treated surgically, and in 28 the ulcer was also treated. The mean perforation time before treatment was 14 +/- 12.3 hours. The immediate postoperative results and long-term evolution were evaluated on the basis of the medical history, follow-up check-ups and home questionnaires. The were post-operative complications in 33 (23%) of the 137 patients who survived surgery; there was no difference in morbidity between the group in which only Closure and Epiploplasty (group C + E) were performed and group CD, where some type of definitive surgery was added, although the seven deaths belonged to the former. Of the 104 patients who were evaluated on a long-term basis (follow-up period of 55 +/- 44 months), poor results were obtained in 58 of the 82 belonging to group C + E and in four of the 28 in group CD, with a total of 13 re-operations (12 and one, respectively). Only a previous ulcer history dating from over three months had any effect on the appearance of recurrences in group C + E. We recommend performing a VGP within the first six hours as the preferred technique for pyloric or juxtapyloric perforations in patients with a previous ulcer history exceeding three months, since the rate of cure is satisfactory and there are few if any complications.

Adolescent↗
PubMed2003

[Treatment of complicated peptic ulcer: personal experience].

BACKGROUND: The availability of drugs which can effectively inhibit gastric secretion allowed the control of the peptic disease in almost all the patients, but the incidence of complications is substantially unchanged. METHODS: In the present study, we performed a retrospective evaluation of 153 patients treated for complicated peptic ulcer (hemorrhage and perforation) in the last 6 years. Hemor-rhage is a common onset of the peptic disease and it rarely requires a surgical treatment, because medical and endoscopic therapies are successful in a high number of patients. RESULTS: Surgery was necessary in 17.2% of the cases in the group of patients studied. CONCLUSIONS: Our experience confirms the high operative mortality in the patients who underwent surgery for hemorrhage related to complicated peptic ulcer because of the frequent presence of several risk factors. Surgical therapy is the main procedure of treatment of perforated peptic ulcer and in the group of patient examined all the cases of perforation underwent surgical operation. In conclusion, despite the progress of pharmacological and endoscopic therapies, surgical treatment is the best therapy of complicated peptic ulcer.

Adult↗
PubMed1960

Serum amylase in peptic gastroduodenal perforation. A study to determine the significance of abnormally high levels.

Elevated serum amylase is a frequent concomitant of perforated gastroduodenal ulcer. To determine if there might be significant correlation between an increase in amylase and some of the other factors associated with ulcer perforation, a study was made of the clinical records of 1,000 patients with perforation of gastroduodenal ulcers. Sixteen per cent of the patients had amylase levels of 200 Somogyi units or more. This rise in serum amylase comes about in cases of perforated peptic ulcer as a result of peritoneal lymphatic absorption of fluid containing pancreatic enzyme which is spilled through the perforation. Among patients with perforated ulcers and elevated serum amylase levels, the higher the amylase level, the higher the mortality rate. The factors of amount of abdominal fluid spill, the duration of the perforation before surgical closure, the size of the perforation, shock and recent ingestion of food were also studied for possible relationship with elevated serum amylase. All appeared to be statistical if not etiological associates of abnormal serum amylase levels. Because high amylase values so often occur in perforated ulcer, there is no amylase level that can be considered diagnostic of acute pancreatitis.

Amylases↗
PubMed2004

Surgical management of perforated duodenal ulcer: the changing scene.

To determine the management of perforated duodenal ulcer at the University Hospital of the West Indies (UHWI) in this era of Helicobacter pylori, the medical records of all patients seen at the UHWI during the period July 1997 to June 2002 with an intra-operative diagnosis of perforated peptic ulcer were reviewed The records were analyzed for the following: age, gender, duration of symptoms, non-steroidal anti-inflammatory drug (NSAID) use, smoking status, operative repair duration of hospitalization, Helicobacter pylori status and medical therapy, peri-operative complications, mortality and recurrence. Ninety per cent of the cases were males. All females in whom perforation occurred were age 50 years and older compared to males where 58% of cases presented before age 50 years. Perforations in acute ulcers occurred in 80% of cases. The majority of patients were male smokers. Non-steroidal anti-inflammatory drug use was also an important risk factor in elderly females. Simple surgical closure and standard triple therapy antibiotics to eradicate Helicobacter pylori was the most common treatment offered. Mortality was one per cent and follow-up poor but 11% of patients had documented recurrent peptic ulceration. In this study population, perforated duodenal ulcer occured overwhelmingly in males less than 50 years of age. There is a trend towards exclusive simple surgical closure and H pylori eradication at the UHWI for patients with perforated duodenal ulcer but this needs to be supported by documentation of H pylori prevalence in the population of patients presenting with perforated peptic ulcers.

Adolescent↗