Cases Of Perforated Peptic Ulcer Research Articles

النتيجة الجراحية لتدبير القرحة الهضمية المثقوبة (مستشفى الجمهوري العام، صنعاء – اليمن، من يناير 2017 إلى يناير 2020)

خلفية الدراسة: القرحة الهضمية المثقوبة (PPU) هي حالة طارئة جراحية تهدد الحياة بشكل شائع. أدى اكتشاف الحلزونية البوابية (1985) إلى تغيير مفهوم إدارة القرحة الهضمية. يوصى بتقليل إنتاج حمض المعدة الآن بعد يوم باستخدام مثبطات مضخة البروتون جنبًا إلى جنب مع القضاء على الحلزونية البوابية. هدف الدراسة: تحليل النتيجة الجراحية لتدبير القرحة المعوية المثقبة في مستشفى الجمهورية خلال 2017-2020. الطريقة: تم تأكيد الحالات المشتبه بها سريريًا من PPU عن طريق الفحص الإشعاعي والمختبر. تعرض هؤلاء المرضى لاستئصال البطن الاستكشافي مع إصلاح رقعة غراهام بعد إنعاش السوائل بشكل كافٍ مع حالة ديناميكية الدم المثلى مع التصريف البريتوني بعد الجراحة، احتفظ هؤلاء المرضى في وحدة العناية المركزة المركزة للأطفال وخضعوا للمراقبة الدقيقة تم جمع البيانات وتبويبها وتحليلها. النتائج: تم تسجيل 62 حالة.. كان المرضى الذكور هم السائد من الإناث بنسبة 60: 2. يتراوح العمر من 20 إلى> 60 سنة. تنتمي غالبية المرضى إلى الفئة العمرية 30-40 سنة. كانت معدلات المراضة والوفيات (20%) و (3.2%) على التوالي. الاستنتاجات: إن الإنعاش الملائم بالسوائل مع حالة الدورة الدموية المثلى ووظيفة الكلى المثلى هو المفتاح لتقليل معدلات المراضة والوفيات. إن الإغلاق البسيط بالرقعة المثقوبة متبوعًا باستئصال الحلزونية البوابية فعال مع نتائج ممتازة في معظم الناجين على الرغم من ظهوره المتأخر لم يعد يتم إجراء الجراحة النهائية لتكرار القرحة إلا في حالة خاصة.

Factors Affecting Outcome in the Management of Peptic Perforation

Perforated peptic ulcer is one of the commonest surgical emergencies. Advanced age, preoperative shock, coexisting medical illness and delay in treatment are common risk factors associated with increased mortality and morbidity. Hence patients should be assessed and treated early. The present study is carried out in respect to the above critical and prognosis bearing factor. 380 cases of perforated peptic ulcer admitted to V.S.S. Medical College Hospital, Burla were studied from September, 2010 to August, 2012. Those cases that were lost to follow up were excluded from the study.

Helicobacter pylori in gastroduodenal perforation

Background:peptic ulcers were earlier believed to be caused by dietary factors, gastric acid, and stress. However, in 1983, Warren and Marshall identified the correlation between Helicobacter pylori (H. pylori) and peptic ulcers. It is now well established that most of the peptic ulcers occur as a result of H. pylori infection. But the co-relation between perforated peptic ulcer and H. pylori infection is not yet fully established. Aims and objectives : to study the prevalence of H. pylori infection in patients with perforated peptic ulcer. Materials and methods: this was a prospective study carried out in all cases of perforated peptic ulcer reporting in surgical wards of a medical college during 2008-2010. A total of 50 cases, presenting as acute perforation of duodenum and stomach during this period, formed the study group. After resuscitation, all the cases were subjected to emergency exploratory laparotomy. The exact site of perforation was identified, biopsy was taken from the ulcer margin from 2-3 sites and the tissue was sent for H. pylori culture and histopathological examination. Simple closure of perforation, omentoplasty, thorough peritoneal lavage and drainage was carried out. Results: out of the 50 cases of perforated peptic ulcer, 38 happened to be males, and only 12 were females. The age of the patients ranged from 20 to 70 years. All the patients underwent only emergency laparotomy. As many as 46 cases (92%) turned out to be positive for H. pylori and only four cases (8%) were negative for this infection. Postoperatively, patients who were found to be positive for H. pylori were put on anti-H. pylori treatment. Conclusion: there was a high prevalence of H. pylori infection in patients with perforated gastroduodenal ulcers.

Perforated Peptic Ulcer of the Jejunum with Ectopic Gastric Mucosa

Ectopic gastric mucosa (EGM) of the jejunum is rare. We report an 81-year-old man with perforated peptic ulcer of the jejunum originating from EGM. Emergency segmental resection of the jejunum was performed with satisfactory immediate results. Diagnosis after surgery was established by histopathology. In addition, sections were examined immunohistochemically using antibodies against MUC5AC, MUC6 and MUC2. Hematoxylin-eosin-stained sections showed glandular differentiated tissue interposed between normal small bowel epithelium. EGM was positive for MUC5AC and MUC6, and negative for MUC2. Histological examination of the resected specimen confirmed that the perforation was caused by a peptic jejunal ulcer associated with EGM. To our knowledge, this is the first reported case of perforated peptic ulcer of the jejunum with EGM in an elderly patient.

Perforated peptic ulcer associated with abdominal compartment syndrome

Abdominal compartment syndrome (ACS) is defined as an increased intra-abdominal pressure with adverse physiologic consequences. Abdominal compartment syndrome caused by perforated peptic ulcer is rare owing to early diagnosis and management. Delayed recognition of perforated peptic ulcer with pneumoperitoneum, bowel distension, and decreased abdominal wall compliance can make up a vicious circle and lead to ACS. We report a case of perforated peptic ulcer associated with ACS. A 74-year-old man with old stroke and dementia history was found to have distended abdomen, edema of bilateral legs, and cyanosis. Laboratory tests revealed deterioration of liver and kidney function. Abdominal compartment syndrome was suspected, and image study was arranged to find the cause. The study showed pneumoperitoneum, contrast stasis in heart with decreased caliber of vessels below the abdominal aortic level, and diffuse lymphedema at the abdominal walls. Emergent laparotomy was performed. Perforated peptic ulcer was noted and the gastrorrhaphy was done. The symptoms, and liver and kidney function improved right after emergent operation.

Twelve years’ progress in surgery for perforated gastric and duodenal ulcers: a retrospective study of indications for laparoscopic surgery, post‐operative course and the influence of Candida infection

SummaryBackgroundTwelve years has passed since we introduced laparoscopic surgery for gastroduodenal perforation.AimTo list problems and to investigate the feasibility of our clinical protocol for treatment of gastroduodenal ulcer perforation.MethodsCase records of 62 patients and histology samples of 9 patients undergoing surgery for gastroduodenal perforation were retrospectively reviewed.ResultsLaparoscopic omental implantation is feasible for some cases of perforated peptic ulcer in patients who have either stenosis or massive perforations. In patients undergoing laparoscopic omental implantation, oral ingestion of water was started at 3.3 ± 0.5 post‐operative days. Helicobacter pylori was positive in 27 of 35 patients (77%). Of 22 cases in whom intraoperative ascitic culture was taken, Candida was positive in nine (41%), and in six of eight cases involving wound infection or intraperitoneal abscess. Histological examination of resected stomach revealed the fungi with hypha formation at the base of the ulcer in 44% of patients.ConclusionsLaparoscopic omental implantation was more feasible than in the past. The possibility of Candida infection and subsequent abscess formation must be considered in patients with gastroduodenal ulcer perforation.

Twelve years’ progress in surgery for perforated gastric and duodenal ulcers: a retrospective study of indications for laparoscopic surgery, post‐operative course and the influence of Candida infection

SummaryBackgroundTwelve years has passed since we introduced laparoscopic surgery for gastroduodenal perforation.AimTo list problems and to investigate the feasibility of our clinical protocol for treatment of gastroduodenal ulcer perforation.MethodsCase records of 62 patients and histology samples of 9 patients undergoing surgery for gastroduodenal perforation were retrospectively reviewed.ResultsLaparoscopic omental implantation is feasible for some cases of perforated peptic ulcer in patients who have either stenosis or massive perforations. In patients undergoing laparoscopic omental implantation, oral ingestion of water was started at 3.3 ± 0.5 post‐operative days. Helicobacter pylori was positive in 27 of 35 patients (77%). Of 22 cases in whom intraoperative ascitic culture was taken, Candida was positive in nine (41%), and in six of eight cases involving wound infection or intraperitoneal abscess. Histological examination of resected stomach revealed the fungi with hypha formation at the base of the ulcer in 44% of patients.ConclusionsLaparoscopic omental implantation was more feasible than in the past. The possibility of Candida infection and subsequent abscess formation must be considered in patients with gastroduodenal ulcer perforation.

What has happened to perforated peptic ulcer?

The number of elective operations for chronic peptic ulceration has decreased substantially with the widespread use of H2-receptor antagonists. We have reviewed all cases of perforated peptic ulcer in Oxford over the last 18 years (1965-82) to see if a similar change in the incidence of this major complication of peptic ulceration has occurred. Since 1976 there has been a fall in the incidence of perforated peptic ulcer from 8.7 to 6.9 cases per 100 000 population per year. The male to female ratio decreased over the review period from 4.9:1 to 1.9:1 owing to a reduced incidence of perforation in men and an increased incidence in women. The mean age of men with perforated duodenal ulcer increased from 52.3 years in 1965-70 to 59.0 years in 1977-82. One hundred and sixty-six patients treated between 1977 and 1982 have been reviewed in detail. The overall mortality in this 6 year period was 12.7 per cent with an operative mortality rate of 8.9 per cent. The majority of perforations (65 per cent) are now of acute ulcers and therefore are unlikely to be prevented by improved therapy for chronic peptic ulceration.

PERFORATED PEPTIC ULCER: AN ANALYSIS OF 246 CASES1

An analysis of 246 cases of perforated peptic ulcer, treated at the Royal Newcastle Hospital from 1964 to 1974, is presented. The incidence has fallen considerably over that period. The rising proportion of women has reached a plateau. A perforated peptic ulcer in an Australian women is still just as likely to be located in the stomach as in the duodenum. In men, however, 84% of perforations are pyloroduodenal. A perforated gastric ulcer is closely associated with the use of salicylate preparations. The mortality rate has remained steady at 15% over the last 30 years. It is significantly higher in women. There is a highly significant relationship between the mortality and (a) the duration of perforation; and (b) the size of the perforation, particularly if it is located in the stomach.

Definitive surgery for perforated peptic ulcer in Malaysia.

Seventy‐three cases of perforated peptic ulcer (51 duodenal and 22 gastric) are reviewed. The condition is common in the Chinese, but rare in Malays, Indians, Pakistanis and Ceylonese. Simple closure is followed by a high recurrence rate. Emergency definitive surgery is safe. Difficulties with follow‐up of patients favour a wider use of emergency definitive surgery for perforated peptic ulcer in Malaysia.

Treatment of acute perforation of peptic ulcers. A 25 year review.

This report is based on a study of 514 cases of perforated peptic ulcer. Follow-up data were obtained for periods ranging from less than a year to more than 22 years in 285 of the 449 cases in which the patients survived simple closure of the perforation. In 101(35.5 per cent) of these 285 cases, the patients were free of symptoms when they were last seen. Ulcer symptoms persisted or recurred in 166 (58.2 per cent) of the 285 cases, and an operation was performed later in 110 of these 166 cases.

PERFORATED PEPTIC ULCER: RADIOLOGICAL REVIEW OF 50 CONSECUTIVE CASES

SUMMARY 1 50 proven cases of perforated peptic ulcer have been reviewed. 2 The radiodiagnostic features of this condition are free gas in the peritoneal cavity and an adynamic ileus due to free fluid. 3 A standard technique for all cases of acute abdomen has been described. 4 The relation of time and size of perforation have been discussed. 5 The value of the radiological investigation has been compared with other writers and an accurate diagnosis made in 88% of the cases.

Perforated peptic ulcer treated by the nonoperative method.

One hundred and forty-nine cases of perforated peptic ulcer have been treated by the nonoperative method by two surgeons in U.S. Public Health Service hospitals. Of these, 107 were consecutive cases; the remaining 42 were selected cases. The mortality rate of the 149 cases was 1.34 per cent.

Two cases of perforated peptic ulcer occurring as postoperative complications of esophagectomy with jejunal interposition.

Bansmer, Gustav M.D.; Bill, Alexander H. Jr. M.D.; Crystal, Dean K. M.D. Author Information

Acute perforated gastroduodenal ulcer

A series of 160 cases of perforated peptic ulcer from the Southern Pacific General Hospital has been presented. Of this number 149 (94.4 per cent) were treated surgically, consisting for the most part of simple closure. The remaining eleven (5.6 per cent) were treated by conservative measures. For the most part impression at operation was the inadequacy of the peritoneum in sealing off the perforation, particularly the gastric. Gastric ulcers appeared to occur in an older age group and to be associated with a higher mortality rate (ten of forty-two or 23.8 per cent) than the duodenal perforations (ten of 109 or 9.2 per cent). For the total number of patients treated (151) there were twenty deaths or a mortality rate of 13.24 per cent. Since the advent of the routine use of adequate amounts of penicillin in this hospital in May, 1946, until July, 1951, there have been only two operative deaths in thirty-eight perforations, a mortality of 5.26 per cent. One of these occurred in a seventy-two year old Negro operated upon six to seven days following perforation and found to have massive intra-abdominal abscesses. The last twenty-three duodenal perforations have been treated surgically without a single death. Subtotal gastric resection has had to be carried out in fifteen patients in this series because of continuation of symptoms, namely, pain or obstruction. There was one death in this number, a mortality rate of 6.6 per cent. Satisfactory results have been obtained in the remaining fourteen cases.

Nonoperative treatment of perforated duodenal ulcer.

One hundred and six cases of perforated peptic ulcer were treated without operative closure. Only one death occurred due to coronary thrombosis. In addition, four patients died, having been moribund on admission. Treatment consisted of continuous effective gastric decompression, combined intravenous administration of antibiotic and chemotherapeutic agents, sedation and parenteral feeding.

Analysis of fifty cases of perforated peptic ulcer

This study is based on a series of fifty cases of perforated peptic ulcer treated at the Cumberland Hospital during a seven year period from 1931 to 1937. The average age of these fifty male patients was thirtynine years. There appears to be a seasonal incidence for the occurrence of this condition. The majority of cases occurred in the fall months of September, October and November. Most of these patients had a definite history of peptic ulcer symptoms for an average duration of three and onehalf years prior to perforation. The history of a sudden, sharp, severe abdominal pain followed by radiation of the pain to the shoulders appears important in the diagnosis of this condition. Objectively, the presence of marked abdominal tenderness, and rebound tenderness, with board-like rigidity of the abdominal muscles, and obliteration of liver dulness with a definite leucocytosis, make the diagnosis of the case conclusive. The most important factor in determining the outcome is the interval of time between perforation and operation. The mortality rises sharply as this length of time increases. The simplest of operative procedures, namely, aspiration of the fluid and closure of the perforation, carried out with the least additional trauma is the procedure indicated. Generalized peritonitis appears to be the cause of death in a majority of the fatal cases. It appears unlikely that this may be influenced in any way, by delaying operation to improve the patient's condition, or by changing the operative procedure. A follow-up study of 73 per cent of the cases revealed that most of the patients were entirely free of symptoms, at an average of one and one-half years following the perforation.

Perforated peptic ulcer: An analysis of 100 caseś

1. 1. One hundred consecutive cases of perforated peptic ulcer operated on at the Henry Ford Hospital during the twenty year period from 1917 to 1936, are analyzed. 2. 2. The mortality rate was 20 per cent for the whole series, but was only 11.9 per cent during the last ten years. 3. 3. The improved results are due to better postoperative treatment, including the routine use of blood transfusions and gastric suction. 4. 4. Spinal anesthesia was also a definite factor in reducing the mortality rate. 5. 5. Gastroenterostomy and other gastric operations were performed on 14 per cent of the patients with a mortality rate of 14.3 per cent, while the mortality rate for simple closure was 18.1 per cent. In spite of these figures simple closure is recommended. 6. 6. Drainage was employed in all but one case. The use of drains is advocated because peritonitis is the chief cause of death after perforation. The author wishes to express his thanks to Dr. Henry P. Koehler for his assistance in the preparation of this material.

To the clinic of perforative peptic ulcer

Perforative gastric ulcer, which used to be a relative rarity 15-20 years ago, nowadays becomes more and more frequent in surgeon's work. To confirm this it is enough to point out that the number of cases of perforated peptic ulcer published in the Russian literature alone exceeds well over 1000, and almost every day this figure is increasing.

Perforation of Peptic Ulcer following X-ray Examination with a Barium Meal

ROENTGEN examination of the stomach with the aid of a barium meal is generally considered entirely innocuous, on which account barium studies of the stomach are employed more or less routinely and without discrimination or restriction. That this method of examination, however, is not altogether harmless is attested to by the number of cases in which radiographic investigation with a contrast medium is followed by acute perforation of a peptic ulcer. Publications dealing specifically with the subject of gastro-duodenal rupture as a sequel to the employment of the x-ray include 36 patients, 34 of whom had benign lesions and two malignant. Of the 34 perforated peptic ulcers, Panek reports eight, Eckman five, Hummelman four, Bittrolff three, Amberger, Colmers, and Nussbaum each two. Single instances are recorded by Ein Waldt, Frankenthal, Hijmans van den Bergh, Lang, Meijer, Rosenthal, Steiger, and Utili. Of the two carcinomatous ulcers which perforated following x-ray examination, one is reported by Lepennetier and Deruas and the other by Rovida. That the number of cases published under appropriate titles is by no means representative of the actual incidence is indicated by the frequency with which perforation following x-ray is mentioned incidentally in cases presented for other reasons. Casual mention of rupture occurring shortly after roentgenography is found, for instance, in the articles of Brütt, Dahm, Falta, Fermaud, Finsterer, Speck, and Wolfson and Gray, dealing primarily with other phases of perforated ulcer. Furthermore, there is evidence to show that experience with this accident is not confined to only a few but that it has been observed by many. Eckman states that after citing his five cases at a regional meeting of the American College of Surgeons, “Numerous admissions of such catastrophes were forthcoming.” I have met with the same response at meetings where I have had occasion to mention my own cases. Assuming that the cause and effect relationship between perforation and x-ray examination is a definite one, the question arises as to how serious a hazard is constituted by this diagnostic procedure. The only published statistical reports upon which to base an opinion are those of Panek, Hummelman, and Eckman. Panek writes that among 36 cases of perforated peptic ulcer observed in the Second Surgical Clinic of the University of Vienna between the years 1910 and 1926, eight followed roentgen examination with a contrast medium. These eight cases are divided by the author into two groups, the first including four cases in which rupture occurred within several hours of the x-ray observation, and the second group comprising the remaining four in which perforation followed after an interval of between 30 hours and six days. If the time element in Panek's series is disregarded, it is found that 22 per cent of his perforated ulcers followed the x-ray.