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Results for “PEPTIC ULCER PERFORATION”

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At least 19 recordsLinked to original sources

PubMed1990

A multifactorial analysis of mortality and morbidity in perforated peptic ulcer disease.

Perforated peptic ulcer disease remains a source of considerable morbidity and mortality, and the suggested methods of surgical therapy are diverse. We reviewed the course of 113 patients who were treated surgically and identified 14 factors that influenced the morbidity or mortality rates, or both. Multiple regression analysis showed that the number of coexisting medical conditions, a lower mean blood pressure level and the duration of acute perforation were independent risk factors for death, while age, use of a bronchodilator, a lower mean blood pressure level and the number of coexisting medical conditions correlated positively with all complications. A duodenal site was independently favorable with respect to all complications. The type of operation performed either simple closure, vagotomy and drainage or resection, did not influence morbidity or mortality. The most severely ill patients also did not benefit from any particular type of operation in the short term. Long term results were improved with definitive operation, as measured by the Visick classification and the need for reoperations. Definitive operations are recommended for virtually all patients with perforated peptic ulcer.

Age Factors↗

PubMed2004

Therapeutic minilaparoscopy for perforated peptic ulcer.

Laparoscopic repair for perforated peptic ulcer has been demonstrated to be safe and effective. We report our initial experience of applying therapeutic minilaparoscopy for peptic ulcer perforation. Five patients with perforated peptic ulcers managed by a team of surgeons using minilaparoscopy are reported. There were no conversions, perioperative morbidity, or mortality. Patients experienced minimal wound pain and required minimal parental analgesia. The access wound scars were hardly discernable at 3-month followup. Therapeutic minilaparoscopy is technically feasible for patients with perforated peptic ulcer and is associated with satisfactory clinical and cosmetic outcome.

Adult↗

PubMed2006

Perforated peptic ulcer: use of pre-admission oral glucocorticoids and 30-day mortality.

BACKGROUND: Despite evidence that use of glucocorticoids increases the risk of complicated peptic ulcer disease, limited data exist on how use of oral glucocorticoids affects outcome for patients with peptic ulcer perforation. AIM: To examine 30-day mortality from peptic ulcer perforation among pre-admission oral glucocorticoid users compared with non-users. METHODS: We identified 2061 patients with a first-time hospital discharge diagnosis of perforated peptic ulcer, using population-based discharge registries in three Danish counties. Data on use of glucocorticoids and other ulcer-related drugs, previous hospitalizations for uncomplicated peptic ulcer disease, and comorbidity were obtained from discharge registries and prescription databases. Follow-up data on mortality were provided by the Danish Civil Registry System. RESULTS: A total of 228 patients (11.1%) were exposed to glucocorticoids within 60 days of admission. Overall 30-day mortality rate was 25.2%, the corresponding rate among current glucocorticoid users was 39.4%. Compared with 'never users', the adjusted mortality ratio among current users of oral glucocorticoids alone was 2.1 (95% CI: 1.5-3.1). Among current users of oral glucocorticoids in combination with other ulcer-related drugs the mortality ratio was 1.5 (95% CI: 1.1-2.1). CONCLUSION: Pre-admission use of oral glucocorticoids is associated with up to a twofold increase in 30-day mortality among patients hospitalized with perforated peptic ulcer.

Adult↗

PubMed2003

Helicobacter pylori infection and perforated peptic ulcer prevalence of the infection and role of antimicrobial treatment.

Although the role of Helicobacter pylori infection on noncomplicated peptic ulcer disease has been definitively established, the precise relationship between the organism and complicated ulcer has hardly been studied. The mean prevalence of H. pylori infection in patients with perforated peptic ulcer is of only about 65-70%, which contrasts with the almost 90-100% figure reported in noncomplicated ulcer disease. However, H. pylori infection rates in various studies range markedly from 0% to 100%, suggesting that differences in variables as number and type of diagnostic methods used to diagnose H. pylori infection, or frequency of nonsteroidal anti-inflammatory drug intake, may be responsible for the low prevalence reported in some studies. Recurrent ulcer disease after peptic ulcer perforation mainly occurs in patients with H. pylori infection, which suggests that the microorganism plays an important role in this complication. All patients with perforated peptic ulcer should be treated by simple closure of the perforation and with therapy aimed at healing of the ulcer and eradicating the H. pylori infection, as disappearance of the organism prevents, or at least decreases, ulcer recurrence and ulcer perforation in patients with H. pylori-associated perforated ulcers after simple closure. Therefore, H. pylori eradicating treatment should be started during the immediate postoperative period. The patients with intractable recurrent symptoms of peptic ulcer despite adequate medical treatment, but without H. pylori infection (e.g. a patient using nonsteroidal anti-inflammatory drugs), is probably the only remaining indication for elective definitive surgical treatment of peptic ulcer disease.

Anti-Bacterial Agents↗

PubMed1997

Perforated peptic ulcer: long-term results after simple closure in the elderly.

The relative incidence of peptic ulcer perforation in the elderly is rising, and the optimal surgical treatment has yet to be defined. To evaluate the long-term result after simple closure a follow-up study was initiated at a Swedish community hospital. During 1983-1992 a total of 151 patients were admitted with perforated peptic ulcer; 92 were elderly (i.e., 70 years or older), 63 of whom were operated with simple closure. Mortality at 30 days was 27% (17/63) and the total in-hospital mortality 30% (19/63). After a mean follow-up of 79 months, 14 of the 44 survivors are still alive. So far only three of the survivors have required additional hospitalization for complications of peptic ulcer disease. Because the rate of serious recurrences is low (14%, 6/44), it is concluded that simple closure is an adequate surgical treatment for peptic ulcer perforation in the elderly.

Adult↗

PubMed1999

Surgical approach and prognostic factors after peptic ulcer perforation.

OBJECTIVE: To find out which prognostic factors were important in predicting postoperative mortality and length of hospital stay in patients with perforated peptic ulcers. DESIGN: Retrospective study. SETTING: Teaching hospital, Lund, Sweden. SUBJECTS: 246 patients with perforated peptic ulcer who presented between January 1974 and December 1992. INTERVENTION: Cox proportional hazards analysis. MAIN OUTCOME MEASURES: Influence of age, sex, coexisting disease, duration of symptoms, site of perforation and operative technique on mortality and length of hospital stay. RESULTS: Age over 75 years (p = 0.002), coexisting cardiac or pulmonary disease (p = 0.02), perforation of the cardia or body of the stomach (p = 0.02), lapse of more than 12 hours between start of symptoms and operation (p = 0.006) and type of operation (p < 0.0001) had a significant influence on hospital mortality. Age over 75 years (p < 0.0001) and lapse of more than 12 hours between start of symptoms and operation (p = 0.03) significant influenced the likelihood of a prolonged stay in hospital. CONCLUSION: Patients with perforated peptic ulcers should be operated on as soon as possible. Simple closure is simple and safe with relatively low mortality and short stay in hospital.

Duodenal Ulcer↗

PubMed1997

[Conservative treatment of gastroduodenal peptic ulcer perforations: indications and results].

Surgery is the conventional form of treatment for perforated peptic ulcer. Conservative treatment has however been described, and is still used in rare situations. The present study analyzes the indications and results of conservative therapy in our hospital. Between 1978 and 1995, 332 patients were admitted for perforated peptic ulcer. Twelve (3.5%), with a mean age of 85 (67-93) years, underwent conservative treatment (gastric suction, H2-blockers and broad-spectrum antibiotics). The diagnosis was established on the basis of epigastric pain and the finding of a pleuriperitoneum on the plain film of the abdomen. The indication for conservative treatment was a prohibitive anesthesiological risk in 11 patients and absence of peritoneal sign in one. The evolution was favourable only in 4 patients, who were discharged after a median stay of 18 days. Mortality was 8/12 patients. In one of these, autopsy showed ischemic colonic perforation. Conservative treatment of perforated peptic ulcer is associated with very high mortality. The results suggest that frequent and careful clinical monitoring is essential during the first 24 hours. In the event of deterioration, surgery must be reconsidered. In addition, the diagnosis should be confirmed by ruling out perforation of another abdominal organ.

Aged↗

PubMed1994

Adverse effects of delayed treatment for perforated peptic ulcer.

OBJECTIVE: The authors assessed the consequences of delayed treatment for ulcer perforation with regard to short-term and long-term survival, complication rates, and length of hospital stay. SUMMARY BACKGROUND DATA: Important adverse effects of delayed treatment have not been studied previously. Conflicting results have been given with regard to short-term survival. METHODS: One thousand two hundred ninety-two patients operated on for perforated peptic ulcer in the Bergen area between 1935 and 1990 were studied. The effect of delay on postoperative lethality and complications adjusted for age, sex, ulcer site, and year of perforation was analyzed by stepwise logistic regression. The effect of delay on duration of hospital stay adjusted for potential confounding factors was analyzed by Cox proportional hazards regression. Observed survival was estimated by the Kaplan-Meier method, and expected survival was calculated from population mortality data. RESULTS: Adverse effects increased markedly when delay exceeded 12 hours. Delay of more than 24 hours increased lethality sevenfold to eightfold, complication rate to threefold, and length of hospital stay to twofold, compared with delay of 6 hours or less. The reduced long-term survival for patients treated more than 12 hours after perforation could be attributed entirely to high postoperative mortality. CONCLUSIONS: Delayed treatment after peptic ulcer perforation reduced survival, increased complication rates, and caused prolonged hospital stay. To improve outcome after ulcer perforation, an effort should be made to keep delay at less 12 hours, particularly in elderly patients.

Age Factors↗

PubMed2005

Laparoscopic repair for perforated peptic ulcer disease.

BACKGROUND: Perforated peptic ulcer is a common abdominal disease that is treated by surgery. The development of laparoscopic surgery has changed the way to treat such abdominal surgical emergencies. The results of some clinical trials suggest that laparoscopic surgery could be a better strategy than open surgery in the correction of perforated peptic ulcer but the evidence is not strongly in favour or against this intervention. OBJECTIVES: To measure the effect of laparoscopic surgical treatment versus open surgical treatment in patients with a diagnosis of perforated peptic ulcer in relation to abdominal septic complications, surgical wound infection, extra-abdominal complications, hospital length of stay and direct costs. SEARCH STRATEGY: We searched the Cochrane Central Register of Controlled Trials (CENTRAL) on The Cochrane Library (Issue 2, 2004), PubMed/MEDLINE (1966 to July 2004), EMBASE (1985 to November 2004) and LILACS (1988 to November 2004) as well as reference lists of relevant articles. SELECTION CRITERIA: Randomised clinical trials comparing laparoscopic surgery versus open surgery for the repair of perforated peptic ulcer using any mechanical method of closure (suture, omental patch or fibrin sealant). DATA COLLECTION AND ANALYSIS: Primary outcome measures included proportion of septic and other abdominal complications (surgical site infection, suture leakage, intra-abdominal abscess, postoperative ileus) and extra-abdominal complications (pulmonary). Secondary outcomes included mortality, time to return to normal diet, time of nasogastric aspiration, hospital length of stay and costs. Outcomes were summarized by reporting odds ratios and 95% confidence intervals, using the fixed-effect model. MAIN RESULTS: We included two randomised clinical trials, which were of acceptable quality. We found no statistically significant differences between laparoscopic and open surgery in the proportion of abdominal septic complications (OR 0.66, 95% CI 0.30 to 1.47), pulmonary complications (OR 0.37, 95% CI 0.11 to 1.31) or actual number of septic abdominal complications (OR 0.72, 95% CI 0.33 to 1.58). Heterogeneity was significant only for pulmonary complications. AUTHORS' CONCLUSIONS: This systematic review suggests that a decrease in septic abdominal complications may exist when laparoscopic surgery is used to correct perforated peptic ulcer. However, it is necessary to develop more randomised controlled trials that include a greater number of patients to confirm such an assumption, guaranteeing a long learning curve for participating surgeons. With the information provided by the available clinical trials it could be said that laparoscopic surgery results are not clinically different from those of open surgery.

Humans↗

PubMed1985

Non-steroidal anti-inflammatory drugs and peptic ulcer perforation.

A retrospective study is reported in which the ingestion of non-steroidal anti-inflammatory drugs (NSAID) in 269 patients with perforated peptic ulceration and 269 age/sex matched controls admitted between 1973-1982 was compared. A highly significant statistical difference was found (p less than 0.001) in those aged over 65. There was no statistical difference, however, in those aged under 65. Furthermore we have shown a highly statistically significant correlation (p less than 0.0001) between the annual number of patients aged over 65 with perforated peptic ulcers taking NSAID and the annual number of prescriptions issued for these drugs in the region. No such correlation was found for patients aged under 65 years. We suggest that the elderly especially women are unduly susceptible to NSAID associated peptic ulcer perforation, and discuss factors that may account for this.

Adult↗

PubMed2000

Perforated peptic ulcer: is there a difference between Eastern Europe and Germany? Copernicus Study Group and Acute Abdominal Pain Study Group.

BACKGROUND AND AIMS: Ulcer surgery and the epidemiology of peptic ulcer perforation have changed considerably in recent decades. PATIENTS/METHODS: Within two prospective studies, 170 perforated peptic ulcer patients from 12 Eastern European centres and 37 patients from 11 German centres were analysed. RESULTS: The median age of patients was 43 years in the Copernicus study and 49 years in the MEDWIS study (P=n.s.), being higher for MEDWIS female patients (73 vs 53 years, respectively; P<0.05). Female patients made up 17% (29/170) of the Copernicus study and 35% (40/170) of the MEDWIS study (P<0.05). Twenty-three per cent (40/170) of patients in the Copernicus study and 54% (20/37) in the MEDWIS study had gastric ulcer perforation (P<0.001). The proportion of definitive operations was higher in Eastern Europe (41.1%; 67/163) than it was in Germany (16.1%; 5/31) (P<0.01). German patients experienced more general complications than Eastern European patients (35 vs 12%, respectively; P<0.01) and a higher mortality [13% (5/37) vs 2% (4/170), respectively; P<0.01]. Delayed admission > or =12 h and age > or =60 years remained predictors for complications in multivariate logistic regression analysis. CONCLUSION: The proportion of both women and gastric ulcers was higher among German patients, while Eastern European patients underwent more definitive operations. German patients experienced more general complications and a higher mortality. Complications were related to high age and delayed admission.

Acute Disease↗

PubMed2005

Prognostic factors of peptic ulcer perforation.

OBJECTIVES: Today a perforated peptic ulcer (PPU) is a rare condition. However, emergency surgery for perforated ulcer presently carries a mortality risk of up to 30%. The aim of this study is to analyze and define factors influencing surgical prognosis in patients operated upon for PPU. METHODS: We performed a retrospective analysis of 62 patients treated for PPU in Suleyman Demirel University, Surgical Department between January 1995 to January 2004. Univariate analysis was performed to determine risk factors for mortality in PPU by chi-square test, Pearson and Spearman correlation tests using SPSS for Windows statistical software. We accepted statistical significance for p values <0.05. RESULTS: The overall mortality rate was 17.7%. The present study confirms the age, sex, American Society of Anesthesiology (ASA) classification, coexisting medical disease, elapsed time from symptoms to operation, blood pressure, pulse, serum albumin and creatinine levels, hemoglobin level and diameter of perforation as valid prognostic factors in whole series, whereas a previous history of peptic ulcer disease, chronic ingestion history of nonsteroidal anti-inflammatory drugs, alcohol ingestion, smoking habits, site of perforation, type of surgical treatment (simple suture or resection), postoperative complications did not appear to be related to prognosis. CONCLUSION: Age, gender, ASA classification, coexisting medical disease, elapsed time from symptoms to operation, blood pressure, pulse, serum albumin and creatinine levels, hemoglobin level and diameter of perforation are factors significantly associated with fatal outcomes in patients undergoing emergency surgery for PPU. Thus, such factors need to be carefully taken into account during the general workup of patients admitted for PPU.

Adolescent↗

PubMed1993

Pneumogastrogram in the diagnosis of perforated peptic ulcer.

Early diagnosis and surgical intervention is important in the management of peptic ulcer perforation. This study looks at the value of a pneumogastrogram in the diagnosis of patients suspected of having a perforated peptic ulcer. One hundred and twenty-nine patients were studied. Pneumogastrogram increased the diagnostic yield of pneumoperitoneum from 66% following plain erect X-ray examination to 91%. The procedure was free of complications.

Adolescent↗

PubMed1999

[Seasonal periodicity of perforated peptic ulcers].

The aim of the study was to evaluate if the frequency of peptic ulcer perforation depends on the changes of seasons. The investigation was carried out in mountain region of Nowosadecki District. This complication of peptic ulcer disease appeared with constant time trend in the years 1991-95. Considering the whole five year period, the increasing number of new cases was observed on the turn of spring and summer (May, June, July) and in early autumn (September, October). Another pattern of seasonal periodicity is often observed in different regions of the world. Because of that, it may be assumed that not changes of seasons but different environmental factors (also weather changes) may influence the frequency of peptic ulcer perforation.

Duodenal Ulcer↗

PubMed1983

Septic complications of perforated peptic ulcer.

The septic complications of peptic ulcer perforation have not been adequately described in the literature because the sparse microflora usually present in the upper gastrointestinal tract is generally believed to represent a minimal risk. One hundred and eighty-two peptic ulcer perforations (150 duodenal, 32 gastric), seen over 15 years, are reviewed. The septic complications relating to intestinal perforation included intra-abdominal abscess (22 cases), wound infection (26 cases) and generalized bacterial peritonitis (18 cases). The incidence of postoperative abscesses was significantly (p less than 0.05) greater in patients with gastric than with duodenal perforation. In both groups, abscesses were much more frequent when perforation occurred more than 24 hours before operation. The risk of intra-abdominal sepsis following acute peptic perforation is substantial. In such cases, routine anaerobic and aerobic cultures should be done of fluid taken from the peritoneal cavity at operation.

Adolescent↗

PubMed1997

Peptic ulcer perforation before and after the introduction of H2-receptor blockers and proton pump inhibitors.

BACKGROUND: The aim of this retrospective study was to compare patients treated for perforated peptic ulcer before and after the introduction of the H2-receptor antagonists and proton pump inhibitors (PPI) with regard to their medical history, clinical features, methods of diagnosis and treatment, complications, and mortality. METHODS AND RESULTS: During the study period 1974 to 1992 we found a significant reduction in the incidence of peptic ulcer perforation (P < 0.001). Patients admitted during the later period of the study were older and more seriously ill. The incidence of perforation among men decreased, but that among women was stable, thus changing the sex ratio towards a female preponderance at the end of the study period. After the introduction of PPI the relative number of gastric perforations decreased compared with the number of perforations in the duodenum. A relatively higher proportion of patients with gastric perforations was taking acetylsalicylic acid or non-steroid, anti-inflammatory drugs at the time of admission compared with patients with duodenal perforation. Simple suture of the perforation was the operative procedure used in 80% of the patients. CONCLUSIONS: Even though patients were increasingly older and more ill, neither the mortality nor the rate of postoperative complications changed during the study period.

Age Factors↗

PubMed1986

Candida and perforated peptic ulcers.

Patients with perforated peptic ulcers who have Candida isolated from peritoneal culture have been noted to have a poor prognosis. Therefore treatment of such patients with systemic antifungal agents has been considered. Because of the toxicity and expense of such therapy, a review of the association was performed. During 1980 to 1985, 48 patients were operated on for benign perforated ulcer. The mean age of the patient group was 66 years. Intraoperative cultures were obtained in 38 patients. Microorganisms were isolated in 28 (74%) patients. Candida was isolated in 16 (57%) of the positive cultures. The overall mortality rate was 16.7%. The mortality rate for patients 65 years of age or older was 25% compared with 0% for those younger than 65 years old. The mortality rate for patients with Candida in their peritoneal fluid was 18.8%. No patient was treated with systemic antifungal agents. No patient developed candidiasis. Of the 16 patients in whom Candida was isolated, it was the only organism in 10 patients and was found in mixed culture with bacteria in six. The mortality rate for patients with Candida alone was 0%. The mortality rate for patients with mixed cultures was 50%. The presence of mixed cultures correlated strongly with both advanced patient age and shock. These factors have previously been correlated with death. It is concluded that the association between peritoneal Candida and excessive death from perforation is linked by an intervening association to advanced age and shock. In this setting, Candida does not appear to be normally pathogenic and does not require systemic antifungal therapy.

Adolescent↗

PubMed2000

Adverse operative risk factors for perforated peptic ulcer.

INTRODUCTION: Mortality from perforated peptic ulcer still remains high as a result of more perforations in the elderly who are generally more ill. We conducted this retrospective study to determine the adverse operative risk factors for perforated peptic ulcers. MATERIALS AND METHODS: Two hundred and six consecutive patients operated for perforated peptic ulcers from 1 January 1993 to 31 December 1997 were reviewed. RESULTS: Majority (n = 194) of the patients had perforations at the pyloroduodenal region and the remaining 10 patients had perforated benign gastric ulcers. The median age at surgery was 58 years (range 18 to 91 years). Forty-four patients (21.4%) were more than 70 years old. The 30-day operative mortality rate was 10.7% (n = 22). Advanced age (> 70 years), female gender, concurrent major medical illness, perforation developed while hospitalised for other medical illnesses, prolonged perforation (> 24 hours) and preoperative hypotension (systolic blood pressure < 90 mmHg) were indicators for operative mortality by univariate analysis. By logistic regression analysis, only concurrent major medical illness, prolonged perforation and preoperative hypotension were independent adverse risk factors. The operative mortality rate for patients with 0, 1, 2 and 3 independent adverse risk factors were 0%, 11%, 30% and 88%, respectively. CONCLUSIONS: As concurrent medical illness is a non-modifiable factor and preoperative hypotension is usually resulting from treatment delay and inadequate resuscitation, emphasis should place on shortening the time to surgery as well as prompt resuscitation.

Adolescent↗