A statistical analysis of perforated gastric and duodenal ulcers in Japan during the past 40 years.

Abstract

A statistical analysis was performed on patients in Japan with perforated gastric and duodenal ulcers during the past 40 years. Perforated ulcers accounted for 14% of the operated gastric and duodenal ulcers in the 1940s but for only 6.8% in the 1970s. In th e 1940s and 1950s, the proportion of perforated gastric ulcers was higher (about 60%) than that for perforated duo denal ulcers, but the latter increased to about 80% in the 1970s. The mean age of the patients with perforated gastric ulcers was 55 years, and with perforated duodenal ulcers was 32 years. The mean male-female ratio of these diseases was 12.5: 1 (5.8: 1 for perforated gastric ulcers and 13.9: 1 for perforated duodenal ulcers). Intraperitoneal free gas was present in 74 ± 11% of the patients. The major sites of perforation were the duodenum, the gastric antrum, the anterior wall of the lesser curvature of the stomach, and the lesser curvature. Perforations at these sites comprised about 90% of all cases. The mortality rate was only 4.6 % for those treated within 24 hours after the onset of the perforation, but was 32% for those treated after 24 hours. As for surgical procedures, extensive gastrectomy was performed in 87% of the patients and simple closure in the 7.6% with high risk. A Billroth II operation was the most frequent of the various types of gastric resections. The postoperative complications which were frequently seen were failure of the sutures, ileus, serum hepatitis and pulmonary complications. The mortality rate decreased during the past 40 years from 44.8% in the 1940s to 7.5% in the 1970s.