Complication Of Peptic Ulcer Disease Research Articles

S3736 Adenocarcinoma of the Gastric Stump After Billroth II

Introduction: Patients with a prior partial gastrectomy for benign diseases, such as Peptic Ulcer Disease (PUD), are at an increased risk of developing Gastric remnant Carcinomas which generally arise near the anastomotic site. Advancing therapeutics have reduced the prevalence of peptic ulcer gastrectomy, though it may still be indicated in certain instances including; bleeding, perforation, malignancy, and gastric outlet obstruction. Despite decreased gastrectomies performed, the long interval between surgery and the development of cancer has caused the incidence to remain stagnant. Case Description/Methods: A 90-year-old male with a history of PUD status post-Billroth II 57 years prior presented to the hospital with hematemesis. He was admitted to the ICU for hemorrhagic shock and treated with packed red blood cells, IV Pantoprazole, and taken for endoscopy. Unfortunately, the stomach and the middle two-thirds of the esophagus were filled with clotted blood. After more than an hour of irrigation and clot removal, the source of hemorrhage was not found due to the excessive blood. The patient was kept nothing by mouth, given IV erythromycin, and taken for a repeat endoscopy. Again, after copious irrigation and clot removal, a source could not be found. The treatment continued and again endoscopy was performed. During this evaluation, the tissue of the anastomotic region of the stomach was noted to have granularity, friability, erythema, and ulcers. Biopsies were taken, which demonstrated adenocarcinoma of the stomach. The patient decided not to undergo further treatment and was discharged home with hospice care. (Figure) Discussion: Remnant gastric stump cancer after resection of benign disease is a well-recognized complication and is defined as malignancy occurring five or more years after gastrectomy. The incidence is between 0.5-1% and typically increases 30 years after the initial gastrectomy. The underlying pathogenesis is thought to be secondary to reflux of biliary contents retrograde into the stomach, causing gastritis, leading to intestinal metaplasia, and the development of adenocarcinoma. Despite the risk, partial gastrectomy continues to be performed for PUD complications after conservative management has failed. While this process takes many years, it should be strongly considered in younger patients when considering partial gastrectomy. Cases such as this may highlight a need for further research and the development of screening guidelines for earlier detection of gastric remnant carcinoma.Figure 1.: Ulcers, granularity, friability, erythema, and congestion in the gastric antrum.

Methods for diagnosing Helicobacter pylori infection at the present stage: advantages and disadvantages for practical application

To date, the diagnosis of Helicobacter pylori infection (H. pylori) remains a topical issue. Current data show that worldwide incidence of H. pylori infection is over 50 % of the world’s population. The prevalence of H. pylori varies in different countries as well as within these countries. Seropositivity to H. pylori progressively increases with age. In developing countries, H. pylori infection is more pronounced among young people than in developed countries. Despite the advances of modern medicine, H. pylori continues to be a serious medical and social problem in the health care system worldwide, causing significant consequences due to the relatively high incidence and mortality from complications of peptic ulcer disease and gastric cancer.
 The article presents modern data on the features of diagnostic methods for H. pylori infection, a comparison of invasive and non‑invasive research methods. Recommendations for the choice of diagnostic methods for H. pylori in patients with gastroduodenal pathology are given.
 Unfortunately, there is no universal method of diagnosis — each method has its advantages and disadvantages. Each method has different sensitivity and specificity. Quite often the choice of diagnostic method depends on its availability and cost. For more accurate diagnosis of H. pylori infection, the use of two or more methods, a combination of invasive and non‑invasive techniques is recommended. Histological method was and is considered the «gold standard» for the diagnosis of H. pylori infection. For screening in the population, it is recommended to use a serological method of diagnosis. Non‑invasive methods (urease breath test or stool test) should be preferred to control H. pylori irradiation. Polymerase chain reaction is the most accurate modern method of H. Pylori diagnosis to determine the molecular — genetic characteristics of the microorganism, assess its virulence, the formation of ideas about the further course and prognosis of the disease.

Treatment outcome of perforated peptic ulcer disease among surgically treated patients: A cross-sectional study in Adama hospital medical college, Adama, Ethiopia

BackgroundPerforation is a life threatening complication of peptic ulcer disease which requires emergency admission and almost always urgent surgical intervention. It is associated with 30% mortality and 50% morbidity. The aim of this study is to assess treatment outcome of perforated peptic ulcers and its associated factors among surgically managed patients. Materials and methodsA 5 year, tertiary hospital-based, retrospective cross-sectional study was conducted on treatment outcome and associated factors among 106 patients operated for perforated peptic ulcers from 2015 to 2020. Omental patch, wedge excision and repair, and total gastrectomy were done by residents and/or consultants in 94, 11, and 1 patient respectively. Treatment outcome was considered favorable if the patient discharged improved and unfavorable if the patient developed complications/died. Logistic regression analysis was conducted to identify associated factors. ResultOut of 106 patients studied male to female ratio was 9:1. The mean age of patients was 36.13 ± 15.6years. Seventy-five (70.8%) patients presented after 24h of onset of symptoms. Most perforations were located on the first part of duodenum in 86 (81.1%) patients. Postoperative complications were identified in 30(28.3%) patients. Being female, delayed presentation, hypotension, and perforation site were significantly associated with postoperative morbidity (P < 0.05). Fifteen (14.2%) patients died in the hospital. Mortality was significantly associated with intra-operative level of contamination and development of post-operative complications (P < 0.05). Conclusionpostoperative morbidity and mortality were significantly associated with delayed presentation and postoperative complications.

Review on Peptic ulcer and its effective Management and Treatment with Herbals

Peptic Ulcer Disease (PUD) is one of the major problems of the gastrointestinal tract occurs in the stomach, duodenum and oesophagus. PUD is characterized by mucosal damage either by pepsin, gastric acid secretion or bacterial infection. Apart from infection due to gram negative bacteria-Helicobacter pylori, regular consumptions of the medications like, NSAIDS, steroids and excessive stress are also some major causes of the PUD. Complications of PUD may include bleeding, perforation, and blockage of the stomach. The PUD is an emerging health challenge in the developed and developing countries. Commonly use of potent synthetic antiulcer chemotherapy arises with adverse effects that might be a cause of serious health challenge. Traditional utilization and scientific reports of medicinal plants in the management of peptic ulcer-like-symptoms urge to redesign the existing clinical approach of using synthetic drugs for the treatment of PUD and adopt the scientifically proven plant drugs for the treatment of PUD which might free or have lesser adverse effects as compared to the synthetic chemotherapy. The review might bestow a strategic planning for the treatment of PUC to the medical practitioners and a newer scope to the researchers to explore the traditional claims of the plant drugs.

Perforated duodenal ulcer in the third trimester of pregnancy, with survival of both the mother and neonate, in Ethiopia: a case report

BackgroundPerforated peptic ulcer disease is a serious complication of peptic ulcer disease (PUD) that presents as acute abdomen. It is very uncommon during pregnancy, but its diagnosis in pregnancy is very challenging in general, and more so in the third trimester. Timely diagnosis and prompt surgical intervention can prevent maternal and fetal mortality, but delayed diagnosis is linked with poor maternal and fetal outcomes. The aim of this case report is to emphasize the need for healthcare professionals to consider the differential diagnosis of perforated PUD when presented with cases of acute abdomen in pregnancy and to involve a multidisciplinary team in management for better feto-maternal outcome.Case presentationA 35-year-old pregnant Ethiopian woman, Gravida 7 and Para 6, presented with a sudden onset of right upper quadrant pain, nausea, and vomiting of 7 hours duration at 36 weeks of gestation. She also had contractions and leakage of liquor of two hours duration. Her abdomen was grossly distended, rigid, and diffusely tender, and showed limited movement with respiration. An upright abdominal X-ray demonstrated air under the diaphragm. She was diagnosed with perforated peptic ulcer disease. Labor was augmented, and a 2.9-kg live male neonate was delivered vaginally. Two hours after delivery, laparoscopic omental patch repair was performed. The patient was discharged 7 days after the omental patch repair surgery in stable condition.ConclusionsPerforated PUD in pregnancy is a rare occurrence, which may account for the delay in diagnosis and management. Obstetricians should keep a high index of suspicion when a pregnant woman presents with acute abdomen. Care provided by obstetricians should be coupled with care provided by other disciplinary teams, in order to reduce maternal and fetal morbidity and mortality.

Peculiarities of diagnostics of atypical course of perforated duodenal ulcer (clinical case)

Aim – to describe a clinical case of atypical course of complications of peptic ulcer disease and the possibility of timely urgent diagnosis. Materials and methods – a clinical case of atypical course of a perforated duodenal ulcer. The clinical case described demonstrates the difficulties of diagnosis in case of lack of time, a dubious clinical picture, ambiguous X-ray data, which requires a more thorough clinical analysis of the available information by urgent brigade of surgeons. For the timely diagnosis of surgical complications of peptic ulcer disease, it is necessary to use modern imaging methods.

COVID-19 related stress and the risk of perforated peptic ulcer: a cross-sectional study

Introduction: Perforated peptic ulcer (PPU) is the fatal complication of peptic ulcer disease and is associated with increased morbidity and mortality of patients. Psychological stress significantly increases the risk of developing PPU. This coronavirus disease 2019 (COVID-19) pandemic causes fear and uncertainty, increasing psychological stress and perceived stress. This study aims to analyze the effect of COVID-19 pandemic high psychological stress as a risk factor for developing PPU. Methods: A cross-sectional study was conducted on all adult patients diagnosed and that underwent surgery for PPU from July 2017 to March 2021. The nonpandemic group consists of patients who underwent PPU surgery from July 2017 to February 2020 and the pandemic group from March 2020 to March 2021. Perceived stress is collected from the patient during the follow-up visit using an Indonesian version of the Perceived Stress Scale (PSS-10) questionnaire. Results: A total of 53 patients with PPU underwent surgery in our hospital. Twenty-five patients from the nonpandemic period and 28 patients during the pandemic period. There was a significant increase in postoperative complication or morbidity rate (78.5% vs. 52%; prevalence ratio: 1.51, 95% confidence interval: 0.99–2.31; P=0.041) in pandemic group. Stress level were also higher in the pandemic group compared with the nonpandemic group (42.1% vs. 5.6%; prevalence ratio: 7.58; 95% confidence interval: 1.05–54.69; P=0.006). Conclusions: COVID-19 pandemic impacts psychological stress, consequently increasing the risk of PPU and increasing morbidity.

The surgical management of complicated peptic ulcer disease: An EAST video presentation.

Peptic ulcer disease (PUD), once primary a surgical problem, is now medically managed in the majority of patients. The surgical treatment of PUD is now strictly reserved for life-threatening complications. Free perforation, refractory bleeding and gastric outlet obstruction, although rare in the age of medical management of PUD, are several of the indications for surgical intervention. The acute care surgeon caring for patients with PUD should be facile in techniques required for bleeding control, bypass of peptic strictures, and vagotomy with resection and reconstruction. This video procedures and techniques article demonstrates these infrequently encountered, but critical operations. A combination of anatomic representations and videos of step-by-step instructions on perfused cadavers will demonstrate the key steps in the following critical operations. Graham patch repair of perforated peptic ulcer is demonstrated in both open and laparoscopic fashion. The choice to perform open versus laparoscopic repair is based on individual surgeon comfort. Oversewing of a bleeding duodenal ulcer via duodenotomy and ligation of the gastroduodenal artery is infrequent in the age of advanced endoscopy and interventional radiology techniques, yet this once familiar procedure can be lifesaving. Repair of giant duodenal or gastric ulcers can present a challenging operative dilemma on how to best repair or exclude the defect. Vagotomy and antrectomy, perhaps the least common of all the aforementioned surgical interventions, may require more complex reconstruction than other techniques making it challenging for inexperienced surgeons. A brief demonstration on reconstruction options will be shown, and it includes Roux-en-Y gastrojejunostomy. Surgical management of PUD is reserved today for life-threatening complications for which the acute care surgeon must be prepared. This presentation provides demonstration of key surgical principles in management of bleeding and free perforation, as well as gastric resection, vagotomy and reconstruction. Video procedure and technique, not applicable.

Risk Factors for Recurrence of Peptic Ulcer Disease: A Retrospective Study in Tertiary Care Referral Center

BackgroundsPeptic ulcer disease (PUD) is a common gastrointestinal tract disease characterized by mucosal damage secondary to pepsin and gastric acid secretion. This study evaluated the five-year recurrence rate for patients with PUD and risk factors contributing to PUD relapses.MethodsFrom 2016 through 2021, all patients with endoscopy-proved PUD were identified by reviewing medical records (Best-Care system). Possible risk factors including smoking, nonsteroidal anti-inflammatory drugs (NSAIDs), aspirin, alcohol, caffeine, and steroids were analyzed by multivariate analysis. Treatment outcomes, 5-year recurrence rate, and mortality rate were assessed.ResultsAmong 223 patients, there were 187 (83.8%) diagnosed with endoscopy-proved PUD and 36 (16.2%) diagnosed with clinical PUD. Among them, 126 (56.5%) patients were males, and the mean age was 62±2 years. The five years recurrence rate of PUD was 30.9%. There was no significant difference in the recurrence rate between the duodenal ulcer (33.3%) and the gastric ulcer (28.8%). By univariate analysis, the use of steroids and NSAID and Helicobacter pylori (H. pylori) infection were potential risk factors for PUD (P < 0.005). The common complication of PUD was gastrointestinal bleeding (34.1%). Patients who had a complicated PUD were associated with a higher rate of recurrence (45.9%) compared to the uncomplicated PUD (19.2%) (P > 0.05).ConclusionOur findings demonstrated that the five years recurrence rate of PUD was 30.9%. The use of steroids and NSAID and H. pylori infection were risk factors for recurrence of PUD. PUD places a significant burden on health care systems. Therefore, a multicenter prospective study is needed for effective management to prevent recurrence and complications of PUD.

Perioperative clinical management in relation to emergency surgery for perforated peptic ulcer: A nationwide questionnaire survey.

Perforation is a severe complication of peptic ulcer disease. Evidence regarding perioperative management of patients undergoing surgery for perforated peptic ulcer is scarce without any clear guidelines. This study aimed to investigate the clinical practice and possible differences in the perioperative management of patients undergoing emergency surgery for perforated peptic ulcers in Denmark. The study was an anonymous, nationwide questionnaire survey. All doctors working at general surgical departments in Denmark were included. The questionnaire consisted of four parts; 1) demographic details including job position, subspecialty, geographic location, and surgical experience, 2) pre- and postoperative use of nasoenteral tubes, 3) routine use of nil-by-mouth (NBM) regime, 4) questions regarding postoperative nutrition.Subgroup analyses were performed according to job position and subspecialty. In total, the questionnaire was answered by 287 surgeons, of which 74% were experienced surgeons being able to perform surgery for perforated peptic ulcers independently.Pre- and postoperative nasoenteral tubes were used routinely by the majority of the respondents. One of five surgeons routinely practiced a postoperative NBM regime. Generally, the respondents allowed clear fluids postoperatively without restrictions but were reluctant to allow free fluids or solid foods. Two of three surgeons routinely used tube- or parental nutrition. The results varied depending on job position and subspecialty. After emergency surgery, the postoperative management of patients with perforated peptic ulcers varies considerably among general surgeons in Denmark. Evidence-based national or international guidelines are needed to standardize and optimize the clinical practice.

Emerging Trends and their Impacts on Peptic Ulcer Diseases: Treatments and Techniques

Background: Peptic ulcer disease (PUD) is prevalent in almost all parts of the world. PUD complications are creating a major source of preventable health care expenses. The major factors responsible for the incidence of PUD and its complication have changed over the past few decades after the identification of non-steroidal inflammatory drugs (NSAIDs) and Helicobacter pylori bacterial infection along with a marked increase in the use of proton-pump inhibitors (PPIs) as drug therapy. The management of PUD has become more complex and challenging due to antimicrobial resistance. Objective: The objective of the study was to highlight current therapy and novel techniques used in the treatment of peptic ulcer diseases. Methods: An exhaustive literature search has been conducted across PubMed, Google, Scopus and Web of Science as an electronic database to add the crucial information from the relevant literature. Results: In the present review, we have discussed PUD and its pathophysiology. The recent trends in PUD and possible treatments with novel techniques have also been discussed. The type and presence of ulcers cannot be predicted accurately based on symptoms. The available treatment approaches for peptic ulcers based on their clinical presentation and etiology are anti-secretary therapy, endoscopy to reveal ulcers followed by drug therapy, and triple therapy for H pylori infection. Conclusion: Thus, the popular and effective methods are very beneficial in controlling PUD. The treatment based on diagnosis is the foremost requirement for ameliorating any disorder. In this article, the emerging techniques and development in the treatment and diagnosis of PUD have been reviewed.

Primary versus delayed primary skin closure in operated patients due to perforated peptic ulcer disease: a randomized controlled clinical trial.

Perforated peptic ulcer (PPU) is a life-threatening complication of peptic ulcer disease. This condition is characterized by a dirty abdomen that predisposes to postoperative wound infection. Delayed primary skin closure is occasionally preferred over primary closure to reduce the risk of surgical site infection in dirty abdominal wounds. In primary skin closure, the skin is sutured immediately after surgery. Meanwhile, in delayed primary skin closure, the incision is left open, and sutured after 2-5days. The current research aimed to compare the risk for surgical site infection, length of hospitalization, and mortality rate between primary versus delayed primary skin closure among patients who underwent surgery for PPU. This single-blind randomized clinical trial included 120 patients who were randomly allocated into the primary and delayed primary closure groups. A research assistant who was blinded to the study examined the wounds for surgical site infection based on the 1992 Center for Disease Control criteria. The outcomes were mortality rate and duration of hospitalization. The delayed primary and primary closure groups did not significantly differ in terms of postsurgical wound infection occurring on the 3rd, 7th, 14th, and 30th days after surgery, mortality rate, and duration of hospitalization. In patients who underwent surgery for PPU, delayed primary closure is not recommended over primary closure due to the risk of postoperative surgical site infection.

Ulcère Perforé-Bouché: A Case Report

Ulcère Perforé-Bouché: A Case Report

Association of Helicobacter Pylori With Development of Peptic Ulcer Disease Among Cirrhotic Patients: An Evidence From Population-Based Study.

Background: Helicobacter pylori (H. pylori) plays an important role in causing peptic ulcer disease (PUD) in the general population. However, the role of H. pylori in cirrhotic patients for causing PUD is obscure. There are various studies evaluating H. pylori association with PUD in cirrhotic patients, but the results have been controversial. We sought to analyze the association of H. pylori with the development of PUD in cirrhotic patients from the largest United States population-based database.Methods: We analyzed Nationwide Inpatient Sample (NIS) and Healthcare Cost and Utilization Project (HCUP) data from 2017. Adult hospitalizations due to cirrhosis were identified by previously validated ICD-10-CM codes. PUD and H. pylori were identified with the presence of ICD-10-CM codes in primary and secondary diagnosis fields, respectively. We performed weighted analyses using Chi-Square and paired Student’s t-test to compare the groups. Multivariable survey logistic regression was performed to find an association of H. pylori with PUD in cirrhotic patients.Results: Our study showed that the prevalence of H. pylori infection was 2.2% in cirrhotic patients with PUD. In regression analysis, H. pylori was found to be associated with PUD in cirrhotic patients (OR 15.1; 95% CI: 13.9-16.4; p <0.001) and non-cirrhotic patients (OR 48.8; 95% CI: 47.5-50.1; p <0.001). In the studied population, H. pylori was more commonly seen in the age between 50 and 64 years (49.4% vs 44.1%; p <0.0001), male (63.4% vs 59.9%; p <0.0413), African American (16.3% vs 10.6%; p <0.0001), and Hispanic (26.2% vs 14.9%; p <0.0001). H. pylori is more likely to be associated with complicated PUD hospitalizations (51.2% vs 44.2%; p <0.0067). Alcoholism and smoking were more common in H. pylori group compared to those without (43.6% vs 35.8%; p <0.0001 and 33.7% vs 24.8% p <0.0001, respectively). Factors associated with increased odds of H. pylori infection include African American (OR 2.3, 95% CI: 1.5-3.6), Hispanic (OR 2.6, 95% CI: 1.7-4.0), and smoking (OR 1.5, 95% CI: 1.1-2.2).Conclusion: H. pylori are associated with PUD and concurrent cirrhosis, although it is less prevalent than general population. African American, Hispanic, and smoking were independently associated with increased odds of H. pylori infection. Further studies are required to better understand the epidemiology and confirm our findings.

Peptik Ülser Perforasyonlarında Nonoperatif Tedavi ve Literatürün Gözden Geçirilmesi

Background: Peptic ulcer perforation is a complication of peptic ulcer disease frequently encountered in the emergency departments. Although there are many treatment options ranging from nonoperative treatment to wide resections, surgery is the first treatment option in peptic ulcer perforations. In this article, we aimed to present the feasibility of nonoperative treatment in appropriate and selected cases. Materials and Methods: The data of the patients who were not operated but provided with medical treatment in our clinic between January 2016 and July 2018 were evaluated retrospectively. Results: Three of the patients were male, one of them was female, and the mean age was 58 years (range, 35-79). On physical examination, there were no signs of acute abdomen, only tenderness was observed in the right upper quadrant and epigastric region. Standing direct abdominal radiography revealed free air under the diaphragm in three patients. The diagnosis was made with tomographic findings in one patient. No contrast agent extravasation was observed in any patient. The patients were examined intermittently by a specialist surgeon, oral intake was permitted on the 4th day of hospitalization, and they were discharged on the 7th day on average. Conclusion: Peptic ulcer perforation is a condition, which is still common and requires emergency surgery in case of acute abdomen development. Although the time elapsed after perforation is a factor affecting mortality and morbidity, nonoperative treatment is a method that can be successfully applied under strict physical examination and laboratory follow-up in appropriate and selected patients without diffuse peritonitis and extravasation on CT with water-soluble contrast agent.

S2283 Double Trouble: A Rare Complication of Peptic Ulcer Disease Causing Clinical Dilemma

S2283 Double Trouble: A Rare Complication of Peptic Ulcer Disease Causing Clinical Dilemma

S3584 Endoscopic Evaluation in a Patient with Post-Bulbar Duodenal Ulcer and Stricture

Introduction: Gastric outlet obstruction (GOO) is the least frequent complication of peptic ulcer disease (PUD) in the US after bleeding and perforation. Ulcers located in the pyloric region and duodenum are most causative of GOO. PUD has decreased since the advent of PPI and eradication of Helicobacter pylori. Although most patients have typical ulcer symptoms prior to the development of complications, asymptomatic ulcers necessitate the need for endoscopic evaluation. Early suspicion and endoscopic evaluation can assist with the prompt management of this complication. Case Description/Methods: 71 year-old white male evaluated for a 5 week history of abdominal pain, nausea, post-prandial vomiting, 35 pound weight loss. Denied the use of non-steroidal anti-inflammatory drugs. Medical history is significant for type 2 diabetes mellitus current tobacco use and hypertension. No prior history of PUD. Physical exam was notable for epigastric tenderness and muscle wasting. Contrasted Abdominopelvic CT showed questionable diverticulum in the second portion of the duodenum and no evidence of pancreatic mass. Endoscopic evaluation showed severe erosive esophagitis, a pinhole stricture in the duodenal bulb with the appearance of a benign peptic stricture. The duodenal stricture was unable to be traversed with a standard gastroscope. With fluoroscopic guidance, the stricture was dilated progressively with a balloon to 6mm, 8mm and 10mm. Biopsies were obtained and the stricture was then traversed with a pediatric scope. After endoscopic evaluation, it was determined that the duodenal stricture was not amenable to durable endoscopic intervention. Pathology, negative for Helicobacter pylori and malignancy. Patient subsequently underwent an exploratory laparotomy and gastrojejunostomy with gastro-jejunal tube placement. Patient continued to improve and was discharged to continue tube feeding at home, outpatient follow up with gastroenterology and surgery. Discussion: Endoscopy plays a critical role in the evaluation and management of patients with symptoms concerning for post bulbar duodenal ulcer, stricture and gastric outlet obstruction. Silent ulcers and complications are more prevalent in older patients. Early detection, evaluation and treatment of GOO could improve disease related morbidity and mortality. Risk modification which consists of tobacco cessation, treating post bulbar ulcers, duodenal ulcers and Helicobacter pylori infection could improve the GOO trends.Figure 1.: Severe Duodenal Stenosis.

A COMPARATIVE OBSERVATIONAL STUDY OF PROGNOSTIC FACTOR SCORES TO PREDICT MORBIDITY AND MORTALITY IN PATIENTS OF PERFORATED PEPTIC ULCER

Background: Perforation is one of the common complication of peptic ulcer disease which is associated with signicant morbidity and mortality. It is a disease which needs emergent surgical intervention. Accurate and early identication of high-risk patients with Perforated Peptic Ulcer is important for risk stratication. Here, we calculate the three prognostic factor scores, (i) The Boey Score, (ii) The Peptic ulcer perforation (PULP) score, and (iii) The quick sequential organ failure assessment (q-SOFA) score, preoperatively to predict postoperative outcome. Aims &amp; Objective: The aim of the study is to identify patients with an increased risk of adverse outcome, so that we can target the level of perioperative monitoring and treatment in high-risk patients. Also, to determine and compare the ability of three prognostic factor scores to predict morbidity and mortality in patients of Perforated Peptic Ulcer. Methods: Aprospective comparative observational study was conducted comprising of 92 patients with conrmed perforated peptic ulcer (PPU) attending the emergency ward of Department of General Surgery between February 2019 to July 2020. After conrmation of diagnosis, risk stratication according to the three prognostic factor scores (Boey score, PULP score, and q-SOFA score) was done. Acomparison was made between each score through calculation of positive predictive value (PPV) and negative predictive value (NPV). We used receiver operating characteristics (ROC) curve in my study to estimate the predictive ability of each scoring system. Results: The study include 92 patients. Female 41.3% and Male 58.7%. The mean age was 45.38 years. The most common site of PPU was the rst part of duodenum - D1 (64.1%). The most common operative procedure done was the Grahm's patch repair. The morbidity rate was 28.3%. Overall mortality rate was 10.9%. The AUROC for morbidity prediction was 0.791 for Boey score, 0.918 for PULP score, and 0.61 for q-SOFAscore. The AUROC for mortality prediction was 0.829 for Boey score, 0.865 for PULPscore, and 0.602 for q-SOFAscore. Conclusion:Boey score and PULP score helps in accurate and early identication of PPU patients with an increased risk of adverse outcome. q-SOFA score cannot signicantly predict morbidity and mortality in PPU patients. Overall, PULP score performs best but Boey score is crude and simple to calculate and is used to assess the patient rapidly

Gastropancreatic Fistula: A Rare Complication of Peptic Ulcer Disease

ABSTRACTPeptic ulcer disease (PUD) has a significant health burden. Penetration is a rare complication of PUD, where an ulcer erodes into another organ. To the best of our knowledge, we present the fourth case in the literature where a gastric ulcer has penetrated the pancreas. A 67-year-old man with a history of PUD presented to the emergency department for epigastric pain. Endoscopy revealed a large gastric ulcer at the incisura with magnetic resonance imaging demonstrating gastropancreatic fistula. Our case emphasizes on the importance of timely identification and treatment strategies for gastropancreatic fistula, the rarest complications of PUD.

MODERN VIEWS ON THE TREATMENT OF PERFORATED PYLORODUODENAL ULCERS

Summary. Purpose: to improve the results of surgical treatment of patients with perforated pyloroduodenal ulcer.&#x0D; Materials and methods. The results of treatment of 101 patients operated on for perforated pyloroduodenal ulcer, which were treated in the surgical department for the period from 2015 to 2020, were analyzed.&#x0D; Results and discussion. Laparoscopic interventions were performed in 56 (55.4 %) patients with perforated ulcer. Excision of perforated ulcer by traditional laparotomy without vagotomy was used in 26 (25.7 %) patients. Suturing of perforated ulcer by traditional method without vagotomy was performed in 19 (18.8 %) patients. Complications of the early postoperative period in 8 (7.9 %) patients were surgical in nature. In 27 (26.7 %) patients postoperative complications were specific associated with the performance of dilated pyloroduodenoplasty. The largest number of postoperative complications was observed in patients who underwent suturing of the ulcer using traditional laparotomy access – 17 (16.8 %), of which general surgery – 6 (5.9 %), specific – 11 (10.9 %).&#x0D; Conclusions. Laparoscopic suturing of perforated ulcers is accompanied by less pronounced pain, a decrease in the number of postoperative complications, which requires greater use of endovideo-surgical technologies in this complication of peptic ulcer disease.