Perforated Gastric Ulcer Research Articles

Gastropericardial fistula with pneumopericardium: an unusual complication of benign peptic ulceration

Perforation of a benign gastric ulcer with the formation of a gastropericardial fistula and pneumopericardium is an extremely rare and frequently fatal complication of peptic ulcer disease. Patients often present with severe substernal chest pain and dyspnea and may rapidly become hypotensive as a result of the accumulation of air and fluid within the pericardial sac and subsequent cardiac tamponade.1-10 The condition is usually fatal, with a mortality of 68% in one series.11 We present a case of a benign gastric ulcer in a hiatal hernia that perforated, resulting in the formation of a gastropericardial fistula and pneumopericardium.

THE TREATMENT AND REAL STATE OF MEDICAL EXPENSES FOR PERFORATION OF DUODENAL ULCER-EVALUATION BY AGES AND THERAPEUTIC METHODS

In this study, we examined the treatments and medical expenses for cases of perforation of duodenal ulcer. As to therapeutic methods, we selected conservative therapy as a rule, but employed ultrasonographyguided puncture drainage or laparoscopic procedure if a large volume of ascites was noted. Emergency operation was performed for patients who did not respond to conservative therapy, those associated with hematological disease, those with perforation of gastric ulcer, and those misdiagnosed. Elective surgery after sucessful conservative therapy was carried out for cases associated with malignant disease and those of frequently recurred ulcer. Each points for hospital stay, medication, treatment, surgical anesthesia, test, imaging diagnosis, as well as total points became larger in aged patients group. There was a tendency for patients who well responded to conservative therapy to decrease the expenses, but all patients who did not respond to conservative therapy were associated with some postoperative complication to became more expensive. Conservative therapy was liable to be excellent for juvenile patients, but it often ineffective for aged patients who also had complications in the clinical course in a high rate. It is indicated that early decision-making for conservative therapy in aged and severe patients and prevention of complications during clinical course may contribute to the saving of medical expenses.

Primary Choledochorrhaphy after Common Bile Duct Exploration

Aim: To prove further the safety of primary closure of the common bile duct. Method: Twenty patients among 99 common bile duct explorations underwent primary closure. Pre- and postoperative liver function test, ultrasound and intraoperative cholangiography data, operation time, postoperative complications and the length of postoperative stay were recorded. Results: Nineteen patients did not suffer any biliary complication. One had bile leakage and bile peritonitis, and another had duodenal leakage. One case was complicated by gastric ulcer perforation. The mean postoperative hospital stay except for the 2 patients with complications was 8.72 ± 0.75 days. Preoperative abnormal liver function tests recovered within 2–3 weeks after the operation. Postoperative ultrasound scan of the biliary tract within 2 months revealed no stenosis and residual stone. Conclusion: Primary common bile duct closure is a safe alternative to routine biliary drainage in selected patients.

A CASE OF CANCER OF THE PAPILLA VATER CAUSING DUODENAL INTUSSUSCEPTION AFTER GASTRECTOMY

A 65-year-old man was seen at the hospital because of abdominal distension. There was a previous history of undergoing a distal gastrectomy with Billroth I method for perforation of gastric ulcer 14 years ago. Upper gastrointestinal series revealed gastrectasis of the remnant stomach. Endoscopic study revealed a cilli-ary elevated lesion at the anal side of the anastomosed site. Biopsy disclosed group III. Because of papillary proliferation of lacunar epithelium on a histologic study, it was diagnosed as stricture due to an adenoma arisen in the duodenum at anal side of anastomosed site. Upon laparotomy, a hen's egg sized tumor was present in the descending portion of duodenum which caused duodenal intussusception. Intraoperative frozen section diagnosis revealed papillary adenocarcinoma, and a pancreatoduodenectomy was performed. The definite diagnosis was carcinoma of the papilla Vater. Abdominal CT performed on the 15th month after the operation demonstrated hepatic metastasis. This operated case of papillary carcinoma showing an extremely rare growth pattern that manifested no jaundice but caused duodenal intussusception is reported.

Smoking and ulcer perforation

Background—The use of ulcerogenic drugs is the only well documented risk factor for peptic ulcer perforation, but accounts for only a quarter of the events. Smoking is a well known...

Extension of indications for local application of Dolgit cream for vertebrogenic pain syndromes

Nonsteroidal anti-inflammatory drugs (NSAIDs) are widely used to relieve the pain (algic) syndrome. However, their oral use is limited because of the development of drug-induced gastropathies, including gastric bleeding, gastric or intestinal ulcer perforations. Risk factors for drug-induced gastropathies include older age, female gender, smoking, taking corticosteroids along with NSAIDs, and a history of gastrointestinal pathology (ulcers, gastritis, bleeding). The risk of gastropathy complications is especially high in those who suffer from chronic gastrointestinal diseases.

Matrix metalloproteinase gene expression in chronic gastric ulcer: a potential role of eosinophils in perforation.

Gene expression of matrix degrading enzymes was investigated in surgical specimens of perforated gastric ulcers. In these ulcers, the inflammatory cells infiltrating into the granulation tissue were granulocytes, particularly eosinophils. The extracellular matrix of the stomach wall consists mainly of collagen types I and III, which are selectively degraded by matrix metalloproteinase-1 (MMP-1). MMP-1 mRNA was detected in the cytoplasm of infiltrating cells, suggesting that eosinophils play an important role in ulcer recurrence and in perforation of the stomach wall. The degree of eosinophil infiltration into an ulcer base may be a useful marker for the risk of perforation. Patients showing this marker may benefit from a prophylactic therapy for preventing severe complications. The control of MMP gene expression represents a potential strategy for the treatment of recurrent gastric ulcer.

PENETRATION OF THE TRANSVERSE COLON BY A FISH BONE DIAGNOSED PREOPERATIVELY WITH COMPUTED TOMOGRAPHY-A CASE REPORT-

A case of penetration of the transverse colon by swallowed fish bones that was diagnosed preoperatively with computed tomography is reported. A 60-year-old man was admitted to the hospital because of colicky abdominal pain and high fever. Abdominal CT examination revealed an intraabdominal abscess including a linear calcified foreign body beneath the abdominal wall at an area superior to the navel and a little to the left of it. We diagnosed the foreign body as swallowed fish bone, and performed an emergency surgery. At surgery, the abscess on the ventricular side of the transverse colon was resected together with a portion of the transverse colon. Two fish bones were found in the abscess. There was a previous history of undergoing a distal partial gastrectomy for a perforated gastric ulcer, and we found moderate intestinal adhesion at this surgery. And he had been drinking heavily everyday. We consider that these histories might contribute to the onset of the disease.

Evaluation of omental implantation for perforated gastric ulcer therapy: findings in a rat model.

Omental implantation, a surgical procedure in which a perforated gastric or duodenal ulcer is repaired by drawing and implanting a portion of the omentum into the digestive tract, accelerates ulcer healing and inhibits ulcer recurrence. However, the mechanisms underlying these beneficial effects are largely unknown. To clarify these mechanisms, we investigated ulcer healing in two groups of rats in which acetic acid-induced gastric ulcers were perforated. Omental implantation was used for repair in one group and simple suturing was employed in the other group. Greater anti-inflammatory and angiogenic activity and accelerated collagen synthesis were seen in the omental implantation group. Basic fibroblast growth factor (bFGF)-mediated angiogenesis was noted in this group, as well as transforming growth factor-beta 1 (TGF-beta 1) activity within and around the omentum, resulting in abundant collagen production. It was confirmed that omental implantation accelerated ulcer healing and inhibited ulcer recurrence, and the presence of bFGF and TGF-beta 1 played a significant role in both these phenomena.

仮性囊胞様を形成した巨大穿通性胃潰瘍の保存的治療の1例

仮性囊胞様を形成した巨大穿通性胃潰瘍の保存的治療の1例

Effect of a pneumoperitoneum on the extent and severity of peritonitis induced by gastric ulcer perforation in the rat

Laparoscopic surgical repair of perforated gastroduodenal ulcer is technically feasible. To study the effect of a pneumoperitoneum on the extent and severity of peritonitis this animal study was devised. In rats gastric ulceration was induced by instillation of ethanol (50%, 2 ml) and followed by gastrotomy to simulate perforation. Animals were randomly allocated to pneumoperitoneum (PP) and control groups. In PP groups CO2 was insufflated intraperitoneally 6, 9, 12, and 24 h after gastrotomy. In controls the abdomen was only punctured. Animals were sacrificed 5 h after the end of PP or abdominal puncture. Blood cultures and intraabdominal swabs were assessed. A peritonitis severity score (PSS) based on histologies from peritoneum, liver, left kidney, spleen, and first jejunal loop was estimated. Six and 9 h after gastrotomy no significant differences between the PP and control groups were observed; 12 h after gastrotomy cultures of blood samples and abdominal swabs were positive in 67% and 75% in the PP group compared to 42% (P < 0.05), and 42% (P < 0.05) in controls. The mean PSS was 20.8 (standard deviation [SD] 2.2) in the PP group compared to 11.3 (1.5) (P < 0.01) in controls; 24 h after gastrotomy cultures of blood samples and abdominal swabs were positive in 83% and 100% in the PP group compared to 42% (P < 0.05) and 50% (P < 0.01) in controls. The mean PSS was 22.1 (1.5) in the PP group compared to 11.8 (2.4) (P < 0.01) in the controls.(ABSTRACT TRUNCATED AT 250 WORDS)

Effect of a pneumoperitoneum on the extent and severity of peritonitis induced by gastric ulcer perforation in rats: [formula omitted], A. Emmermann, H. Treu, E. Achilles, D. Mack, C. Zornig, C.E. Broelsch, Dept. of Surgery, University Hospital Hamburg, Germany

Effect of a pneumoperitoneum on the extent and severity of peritonitis induced by gastric ulcer perforation in rats: [formula omitted], A. Emmermann, H. Treu, E. Achilles, D. Mack, C. Zornig, C.E. Broelsch, Dept. of Surgery, University Hospital Hamburg, Germany

A Case of Gastric Perforation Associated with Concomitant Use of Nonsprescription Drug.

We describe a presumed case of drug-induced gastric perforation arising during treatment of rheumatoid arthritis in an outpatient. A 48-year-old male was given diclofenac sodium and misoprostol at the University Hospital. However, the patient also took two non-prescription drugs produced in Taiwan without the consent of his doctors or pharmacists for about three months. The patient was then admitted to another hospital due to upper abdominal pain. A diagnosis of peritonitis due to perforation of the digestive tract was made by thoracic and abdominal radiography, and extended gastrectomy was carried out. We detected indometacin and prednisolone from one non-prescription drug. From the findings, it was considered that the perforated gastric ulcer in this patient was induced by the concomitant use of a corticosteroid and NSAIDs. In this case, the adverse reaction might have been prevented by sufficient patient counseling about the medication. For high-quality and appropriate pharmaceutical care, the pharmacist must provide patient counseling about non-prescription as well as prescrintion drugs

A CASE OF REACTIVE LYMPHOID HYPERPLASIA OF THE STOMACH WITH PERFORATED GASTRIC ULCER

A 52-year-old man underwent gastrectomy because of a perforated gastric ulcer. Gross observation of the resected specimen showed a normal gastric mucosa but perforated ulcer. Histological examination, however, revealed many lymphoid follicles without atypia, which were proliferated ranging from the mucosal to the subserosal layer of the gastric wall. Immunohistochemically, the infiltrated lymphocytes among the lymphoid follicles did not have monoclonal B-cell or T-cell proliferation, and lymphoid follicles did not show monoclonality for the stainings of light chains of immunoglobulin. This study enabled us to make the final diagnosis of this case as reactive lymphoid hyperplasia of the stomach. The patient is now free of recurrence as of 2 years and 5 months after the surgery. Most of the cases diagnosed as reactive lymphoid hyperplasia of the stomach in Japan were low grade malignant lymphoma, so benign lymphoid hyperplasia like this case is rare.

Laparoscopic Management of Complicated Ulcer Disease.

Laparoscopic surgery for complicated ulcer disease has to be tailored to the specific needs imposed by the pathology and clinical state of the patient. In the elective situation, patients with concomitant reflux esophagitis and duodenal ulcer disease are best treated by partial crurally-fixed posterior fundoplication and highly selective vagotomy. Patients with resistant prepyloric ulcers and those on long-term medication with ulcerogenic drugs require truncal vagotomy and antrectomy. Because many patients with benign pyloric stenosis are elderly and exhibit hypochlorhydria, a drainage procedure without vagotomy is sufficient. The type of drainage performed, gastrojejunostomy or pyloroplasty, depends on the extent of scarring of antroduodenal segment. In the emergency situation, patients with perforated ulcer disease are best treated by simple closure with adequate peritoneal toilet. A definitive procedure should be reserved for fit patients with prior symptoms and limited chemical peritonitis of less than 6 to 8 hours duration. All perforated gastric ulcers should be biopsied at the time of laparoscopic closure. New endogastric techniques are being evaluated for the treatment of patients with bleeding gastroesophageal lesions.

Laparoscopic Management of Complicated Ulcer Disease

Laparoscopic surgery for complicated ulcer disease has to be tailored to the specific needs imposed by the pathology and clinical state of the patient. In the elective situation, patients with concomitant reflux esophagitis and duodenal ulcer disease are best treated by partial crurally-fixed posterior fundoplication and highly selective vagotomy. Patients with resistant prepyloric ulcers and those on long-term medication with ulcerogenic drugs require truncal vagotomy and antrectomy. Because many patients with benign pyloric stenosis are elderly and exhibit hypochlorhydria, a drainage procedure without vagotomy is sufficient. The type of drainage performed, gastrojejunostomy or pyloroplasty, depends on the extent of scarring of antroduodenal segment. In the emergency situation, patients with perforated ulcer disease are best treated by simple closure with adequate peritoneal toilet. A definitive procedure should be reserved for fit patients with prior symptoms and limited chemical peritonitis of less than 6 to 8 hours duration. All perforated gastric ulcers should be biopsied at the time of laparoscopic closure. New endogastric techniques are being evaluated for the treatment of patients with bleeding gastroesophageal lesions.

Gastric ulcer perforation with IM ketorolac

Gastric ulcer perforation with IM ketorolac

Pneumo-omentum following perforated greater curvature gastric ulcer

Two cases are presented which demonstrate the unusual and, to our knowledge, previously undescribed appearance of air within the greater omentum following perforation of benign gastric ulcers directly into the greater omentum.

Fortuitous Esophageal Intubation

Esophageal malposition is a potentially disastrous complication of attempted airway intubation. We report an unusual case in which a promptly recognized esophageal intubation aided detection of a perforated gastric ulcer. After the endotracheal tube was repositioned and the ulcer was surgically repaired, our patient had an excellent outcome.

CLINICAL STUDY ON THE PERFORATED GASTRODUODENAL ULCER

Clinical characteristics were examined in 49 patients with perforated gastroduodenal ulcer treated in the hospital during the recent 4 years. The mean age of the patients with perforated duodenal ulcer was younger than that with gastric ulcer. Many cases of perforated duodenal ulcer occurred at night and in autumn or winter. On the contrary those of perforated gastric ulcer had no such characteristics. Sixty-six point seven, per cent of the patients with perforated duodenal ulcer had no previous history of any ulcer and the patients with a previous history of an ulcer did not have taken H2 blocker at the manifestation. The rate of detection of free gas on abdominal X-ray was 86.7% for the perforated gastric ulcers and 77.1% for perforated duodenal ulcers. No association of preoperative leucocytosis were comparatively predominant in aged patients. The positive ratio of bacteria in the peritoneal cavity increased when the time lapse from manifestation of symptoms to surgery was longer than 6 hours. Forty-nine patients recieved extended gastrectomy and the mortality rate was 0%. Two patients with perioperative sepsis were both aged, had longer time lapse from manifestation of symptoms to surgery, and had no leucocytosis.