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Results for “PEPTIC ULCER PERFORATION”

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PubMed2002

[Peptic ulcer perforation: an analysis of risk factors].

BACKGROUND: Despite decreasing incidence of peptic ulcer disease, peptic ulcer perforation remains a source of mortality. This retrospective study was performed to find riskfactors for mortality and to construct a score that predict outcome for patients with peptic ulcer perforation. METHODS: A review of94 patients operated (primer ciosure and omentoplasty) for perforated peptic ulcer in Iast ten years was undertaken to study. lndependent risk factors for mortality were found with Iinear regression analysis and risk score was constructed using standardized coefficients of risk factors. RESULTS: Acute renal failure (ARF) (p < 0,00 1 ), treatment delay more than 48 hours (> =48 hours) (p = 0,203 ) and age greater than 60 years (> 60 years) (p = 0, 199) were found signijicant factors independently injuencing mortality. The risk score was (Risk score = (ARF)XO,497 + (> =48 hours)XO,203 + (>60years)XO,199). The overall predictive accuracy of risk score was%95. CONCLUTION: Treatment delay and related acute renal failure and advanced age are determining factors for survival after ulcer perforation. Delay of treatment may be only changeable factor for mortality. lt is ciear that, the early diagnosis and treatment aredecreasing operative mortality of peptic ulcer perforation. Every effort to decrease the mortality should be this mannei:

Humans↗
PubMed1967

Perforated peptic ulcer.

Because no large series of perforated peptic ulcers has been reported from Canada, 402 cases from the Ottawa Civic Hospital were reviewed to study this dramatic disorder.The incidence was 15 per 100,000 population annually, or one in every 1000 hospital admissions.The incidence in females and the elderly in this series was higher than reported elsewhere. The risk of perforation increased with age, being greatest after 55; this was not due to an excess of chronic ulcers in older patients, indicating that ageing is an etiological factor.As the mortality of perforated peptic ulcer-20%-had remained unchanged over the years, fatal cases were studied to see if changes should be made in the management of this condition. The mortality for patients undergoing operation was 7.5%. Patients treated conservatively because their general condition was poor, died. Fifteen patients, in whom an incorrect diagnosis was made, died. More aggressive therapy and greater efforts at diagnosis might have saved some of these patients.

Adult↗
PubMed1996

[Our experience in the surgical treatment of perforated peptic ulcer].

The authors report their experience in the treatment of perforated peptic ulcer. From August 1992 to December 1995 a total of 23 patients (14 cases of gastric ulcer and 9 cases of duodenal ulcer), mean age 67.5 years, underwent emergency surgery for perforated peptic ulcer. The operations performed included: simple gastrorrhaphy in 19 cases (11 for gastric ulcer, 8 for duodenal ulcer); gastrorrhaphy with pyloroplasty + GEA in 1 case of gastric ulcer; gastrorrhaphy with pyloroplasty in 2 cases (1 for gastric ulcer, 1 for duodenal ulcer); gastric resection in 1 case of gastric ulcer. One case of perioperative mortality occurred, equivalent to 4.3%, whereas the percentage of complications observed was 13% (2 cases of IRA, 1 case of wound infection). The mean age of patients (67.5 years) and the high percentage of associated major pathologies (39.1%) oriented the choice of therapy towards ulcerorrhaphy. In the authors' opinion this rapid and easy to perform method represents the best treatment of perforated peptic ulcer; the validity of ulcerorrhaphy is confirmed by the reduced mortality (4.3%) and the low percentage of morbidity (13%) found in this series.

Adult↗
PubMed2004

Helicobacter pylori and perforated peptic ulcer prevalence of the infection and role of non-steroidal anti-inflammatory drugs.

AIMS: To study the prevalence of Helicobacter pylori infection in patients with perforated peptic ulcer, to compare it with the prevalence in patients with uncomplicated ulcer, and to assess the role of non-steroidal anti-inflammatory drugs in this prevalence. METHODS: Consecutive patients with perforated peptic ulcer were included in this retrospective study. As a control group, patients undergoing elective outpatient evaluation for the investigation of dyspepsia during the same time period and found to have a peptic ulcer at endoscopy were included. A 13C-urea breath test was carried out in all patients to diagnose H. pylori infection. RESULTS: Sixteen patients with perforated peptic ulcer and 160 with non-complicated peptic ulcer were included. Sixty-two percent of the patients with perforated peptic ulcer were infected by H. pylori, while the microorganism was detected in 87% of the patients without this complication (P = 0.01). Non-steroidal anti-inflammatory drugs intake was more frequent (P = 0.012) in patients with perforated peptic ulcers (56%) than in those without perforation (26%). H. pylori prevalence in perforated peptic ulcers was of 44% in patients with non-steroidal anti-inflammatory drugs intake, but this figure increased up to 86% when only patients not taking non-steroidal anti-inflammatory drugs were considered (P = 0.09). In the multivariate analysis, non-steroidal anti-inflammatory drugs intake was the only variable that correlated with peptic ulcer perforation [odds ratio, 3.6 (95% confidence interval, 1.3-10); P = 0.016]. CONCLUSION: The mean prevalence of H. pylori infection in patients with perforated peptic ulcer is, overall, of only about 60%, which contrasts with the 90-100% figure usually reported in non-complicated ulcer disease. However, the most important factor associated with H. pylori-negative perforated peptic ulcer is non-steroidal anti-inflammatory drugs use, and if this factor is excluded, prevalence of infection is almost 90%, similar to that found in patients with non-perforating ulcer disease.

Adult↗
PubMed1995

Helicobacter pylori infection in perforated peptic ulcer disease.

This study examined a possible aetiological agent, namely, Helicobacter pylori, in perforated peptic ulcer disease and its relationship to persisting ulcer. Twenty-nine patients with perforated peptic ulcer underwent simple closure of the perforation at laparotomy. A 13C urea breath test carried out on the eighth day after operation was positive in 24 patients. Fourteen of 17 patients who underwent upper gastrointestinal endoscopy 6 weeks after discharge from hospital had a positive 13C urea breath test. The biopsy urease test performed on mucosal samples taken at endoscopy was positive in 12 of these 14 patients, indicating continuing active infection with H. pylori. Seven patients with positive 13C urea breath and biopsy urease tests had persisting duodenal ulceration. None of the three patients with a negative 13C urea breath test had evidence of duodenal ulceration at endoscopy. The association between a high rate of duodenal ulcer persistence and a high incidence of H. pylori infection suggests that antibiotic therapy to eradicate this microorganism should be given to all patients with perforated peptic ulcer disease.

Adult↗
PubMed2004

Laparoscopic repair of perforated peptic ulcer: a meta-analysis.

BACKGROUND: Laparoscopic repair of perforated peptic ulcer has been gaining popularity in recent years, but few data exist to support the superiority of the laparoscopic approach over open repair. The objective of the current study was to compare the safety and efficacy of open and laparoscopic repair of perforated peptic ulcer in an evidence-based approach using meta-analytical techniques. METHODS: A search of electronic databases, including MEDLINE and EMBASE, was conducted to identify relevant articles published between January 1990 and December 2002. Only studies in the English language comparing the outcomes of laparoscopic and open repair of perforated peptic ulcer were recruited. All reports were critically appraised with respect to their methodology and outcome. Data from all included studies were extracted using standardized data extraction forms developed a priori. Both qualitative and quantitative statistical analyses were performed. The effect size of outcome parameters was estimated by odds ratio where feasible and appropriate. RESULTS: A total of 13 publications comprising 658 patients met the inclusion criteria. The overall success rate of laparoscopic repair was 84.7% (n = 249). Postoperative pain was lower after laparoscopic repair than after open repair, supported by a significant reduction in postoperative analgesic requirement after laparoscopic repair. Meta-analyses demonstrated a significant reduction in the wound infection rate after laparoscopic repair, as compared with open repair, but a significantly higher reoperation rate was observed after laparoscopic repair. CONCLUSIONS: Evidence suggests that laparoscopic repair of perforated peptic ulcer confers superior short-term benefits in terms of postoperative pain and wound morbidity. This approach is as safe and effective as open repair. Laparoscopic Graham-Steele patch repair of perforated duodenal or justapyloric ulcer is beneficial for patients without Boey's risk factors.

Adult↗
PubMed2005

Perforated peptic ulcer in Tikur Anbessa Hospital: a review of 74 cases.

Little is known on the pattern of perforated peptic ulcer in Ethiopia. To evaluate the early, outcome of management, a five-year retrospective analysis of 74 operated cases of perforated peptic ulcer was undertaken. Perforated peptic ulcer accounted for 3.4% of the adult emergency surgical procedures. The mean age was 32.6 years, with a male to female ratio of 7.2 to 1.0. Fifty-six percent of the cases were unmarried. In nearly 22.0% of the patients, no previous history of peptic ulcer disease was documented. Delay in diagnosis was noted in 95% of the cases. Most patients had duodenal ulcer perforation, and about 78% had purulent peritonitis at laparotomy. Fourteen died in hospital. Early presentation of patients to surgical care facilities may reduce morbidity and mortality in cases of peptic ulcer perforation.

Adolescent↗
PubMed2006

A prospective cohort study of postoperative complications in the management of perforated peptic ulcer.

BACKGROUND: With dwindling rates of postoperative mortality in perforated peptic ulcer that is attributable to H2-receptor blocker usage, there is a need to shift the focus towards the prevention of postoperative morbidity. Further, the simultaneous contribution of several putative clinical predictors to this postoperative morbidity is not fully appreciated. Our objective was to assess the predictors of the risk, rate and number of postoperative complications in surgically treated patients of perforated peptic ulcer. METHODS: In a prospective cohort study of 96 subjects presenting as perforated peptic ulcer and treated using Graham's omentoplatsy patch or gastrojejunostomy (with total truncal vagotomy), we assessed the association of clinical predictors with three domains of postoperative complications: the risk of developing a complication, the rate of developing the first complication and the risk of developing higher number of complications. We used multiple regression methods - logistic regression, Cox proportional hazards regression and Poisson regression, respectively - to examine the association of the predictors with these three domains. RESULTS: We observed that the risk of developing a postoperative complication was significantly influenced by the presence of a concomitant medical illness [odds ratio (OR) = 8.9, p = 0.001], abdominal distension (3.8, 0.048) and a need of blood transfusion (OR = 8.2, p = 0.027). Using Poisson regression, it was observed that the risk for a higher number of complications was influenced by the same three factors [relative risk (RR) = 2.6, p = 0.015; RR = 4.6, p < 0.001; and RR = 2.4, p = 0.002; respectively]. However, the rate of development of complications was influenced by a history suggestive of shock [relative hazards (RH) = 3.4, p = 0.002] and A- blood group (RH = 4.7, p = 0.04). CONCLUSION: Abdominal distension, presence of a concomitant medical illness and a history suggestive of shock at the time of admission warrant a closer and alacritous postoperative management in patients of perforated peptic ulcer.

Adolescent↗