Incidence Of Perforated Peptic Ulcer Research Articles

A simple and effective technique for laparoscopic gastrorrhaphy: modified Graham’s patch with barbed suture

IntroductionPeptic ulcers are caused by unbalanced acid production, and proton pump inhibitors (PPIs) in recent decades have helped to treat peptic ulcers effectively. Meanwhile, the incidence of perforated peptic ulcer (PPU) persists and has a high mortality rate if there is no adequate management. Primary closure with a modified Graham’s patch was well performed in early detected PPU with a small size < 2 cm. A laparoscopic approach for PPU was prescribed for decades with proven feasibility and safety. We introduced an effective technique combined with barbed suture and modified Graham’s patch, which can significantly reduce the surgical time without significantly increasing morbidity and mortality compared with traditional interrupted suture.Patients and methodWe retrospectively collected data from January 2014 to December 2020 in Keelung Change Gung Memorial Hospital, and a total of 154 patients receiving laparoscopic repair of PPU were included. There were 59 patients in the V-loc group (V group) and 95 patients in the laparoscopic primary repair group (P group).ResultsThe V group had a significantly shorter operation time than the P group (96.93 ± 22.14 min vs. 123.97 ± 42.14, P < 0.001). Ten patients suffered from morbidity greater than the Clavien‒Dindo classification 4 (5 from V group, and 5 from P group). Three patients with leakage were reported. Two patients were in the V group, and one patient was in the P group (p = 0.432).ConclusionLaparoscopic repair with barbed suture and modified Graham’s patch provides a simple and effective technique in the management of acute abdomen. This technique can be easily performed by experienced surgeons and trainees in minimally invasive surgery without affecting patient safety.

Rise in incidence of perforated peptic ulcer in young-change in the trends in etiology

Background: A total of 50 patients who were admitted and treated for perforated peptic ulcer, from February 2021 to December 2021, were included in the study to study the recent changes in the trends of etiology of perforated peptic ulcer in the young.Methods: Patients who were diagnosed and treated with perforated peptic ulcer (prepyloric perforation and duodenal perforation) from February 2021 to December 2021 were included in the study. Data regarding dietary habits, use of addictive recreational substances, smoking, tobacco use, and alcohol consumption were collected and tabulated to study the recent trend in the etiology of perforated peptic ulcer in the young.Results: Higher incidence of peptic ulcer perforation seen in young males with history of use of recreational drugsConclusions: There is a rise in cases of perforated peptic ulcers in young males with a history of use of habit-forming substances.

English

BACKGROUND Previous studies have reported seasonal variations in peptic ulcer disease (PUD), but only few large-scale, population-based studies have been conducted in this regard. In this study, we wanted to present the seasonal relationship of peptic ulcer perforation admissions, seasonal variation of its incidence, modes of surgical management, the seasonal distribution of postoperative severe complications and the patient outcome. METHODS This is a retrospective cohort study. Patients hospitalized for peptic ulcer perforation between 1st January 2008 and 1st January 2020 were included in the study. The patients were divided into two groups according to postoperative complication status as Group1 - Clavien Dindo &lt; 3 and Group 2 - Clavien Dindo &gt; 3. Age, gender and seasonal periods were compared. In addition, patients were divided into three groups according to age as 18 – 40 yrs., 40 - 60 yrs. and over 60 yrs. The gender and complication status of the patients were also evaluated in seasonal groups. RESULTS 135 patients participated in our study. Group 1 constituted of 107 patients and Group 2 constituted of 28 patients. Admission to the hospital due to peptic ulcer perforation was most common in spring (29.6 %) and summer (29.6 %). Twenty - eight patients had Clavien - Dindo 3 or more complications. The mean age was higher in Group 2 (70.78 vs 50.2 P : 0.001) as well as female gender dominancy (60.7 % vs 29.9 %). In Group 2 winter months were more frequent (46,5 % vs 21.5 %); however, there was no significant difference between the seasons and the complication groups. In Group 2, female gender was more common in winter (21.7 % vs 69.2 % P:0.005) and autumn season (31.3 % vs 100 % P : 0.027). CONCLUSIONS In our study, we found an increased incidence of peptic ulcer perforation in spring and summer. For patients at higher risk, an appropriate pharmacological treatment can be arranged to reduce the risk of perforation during the risky season. KEY WORDS Peptic Ulcer Disease, Seasonal Change, Complication

STUDY OF INCIDENCE OF PEPTIC ULCER PERFORATION IN YOUNG ADULTS

BACKGROUND: Peptic ulcer formation affects about 2-10% of world population every year with higher incidence in younger individuals. Being a surgical emergency, it has higher mortality and morbidity. Thus the aim of our study was to evaluate the incidence of peptic ulcer perforation based on gender age and also to study its associated risk factors, clinical presentations, site along with surgical management and complications

English

BACKGROUND Around 4 million people are affected by peptic ulcer diseases worldwide annually. The incidence of around 1.5 % to 3 % has been estimated. Peptic ulcer perforation presents with an overall mortality of 10 %. The management is also associated with significant post-operative morbidity and mortality regardless of whether laparoscopic or open repair is performed. In this study, we wanted to find out the incidence of peptic ulcer perforation and its management. METHODS Our study was a prospective observational study conducted in post graduate Department of Surgery, Government Medical College Srinagar, from October 2018 to November 2020. All patients were evaluated properly with all baseline investigations followed by X-ray chest and abdomen and ultrasonography (USG). RESULTS In our study, 136 patients were diagnosed as cases of peptic ulcer perforation. The maximum number of patients were in age group of 41 - 50 years (27.20 %). The male : female ratio was 14.1 : 1. Abdominal pain was present in all patients as presenting symptom followed by abdominal distension. In this study, 124 patients (91.2 %) had perforation in first part of duodenum, 9 patients (6.6 %) had perforation in prepyloric region and 3 (2.2 %) patients had perforation in body of stomach. Graham’s Patch repair was done in 133 patients, 1 patient underwent primary closure, and 2 patients underwent distal gastrectomy with gastrojejunostomy. CONCLUSIONS Our study shows that young people with perforated peptic ulcer have fewer coexisting medical illness, a lower complication rate and a more favorable outcome as compared to elderly patients with perforated peptic ulcer. A majority of such perforations are in 1st part of duodenum with male preponderance. A plain chest radiograph is sufficient to make diagnosis in the classic case of sudden onset epigastric pain. KEYWORDS Perforation Peritonitis, Management of Peptic Ulcer Perforation, Graham’s Repair, Clinical Presentation of Peptic Ulcer Perforation

A HOSPITAL BASED STUDY OF INCIDENCE OF PEPTIC ULCER PERFORATION IN YOUNG ADULTS

Background: Peptic ulcer formation affects about 2-10% of world population every year with higher incidence in younger individuals. Being a surgical emergency, it has higher mortality and morbidity. Thus, the aim of our study was to evaluate the incidence of peptic ulcer perforation based on gender, age and also to study its associated risk factors, clinical presentations, site along with surgical management and complications. Materials &amp; Methods: 75 patients diagnosed with perforated peptic ulcer were included and this study was conducted in the Upgraded Department of Surgery, Darbhanga Medical College and Hospital, Laheriasarai, Bihar. Structured performa was prepared to obtained details of patients. Results: 76% of patients in our study were males and 24% were females with male and female ratio 1:3.16. The prevalence of perforation was high in age group 20-30 years (30.7%). 62.7% of cases had positive family history and the incidence was in the patients who consumed non-vegetarian (84.8%), spicy (61.4%) and oily (69.5%) foods. Frequently observed clinical presentation were abdominal pain followed by tenderness and rigidity and gas under diaphragm. The common site of perforation was duodenum (62.7%) and most of the cases were treated by closure with omental patch (81.3%). The post-surgical complications frequently observed were wound infection (30.6%) and chest infection (28%). Conclusion: Peptic ulcer perforation is common disorder of gastrointestinal tract, now affecting younger adults with male preponderance. It is associated with unwanted health and economic issues. Therefore, earlier management is only the way to minimize complications and mortality

A prospective cohort study of patients with peptic perforation to identify high-risk clinical characteristics

Introduction: Peptic ulcer perforation is the most common complication in peptic ulcer disease and can lead to serious complications and mortality; however, despite the widespread use of antisecretory agents and eradication of Helicobacter pylori, the incidence of peptic ulcer perforation remains largely unchanged. This study aimed to evaluate the risk factors for perioperative morbidity and mortality in patients with peptic ulcer perforation. Methods: This was a prospective, observational study involving patients with perforated peptic ulcer disease admitted to the Al-Basra Teaching Hospital from January 2017 to December 2019. A total of 100 patients were followed for 4 weeks. Patients’ demographic data, history of chronic diseases, American Society of Anesthesiologist (ASA) score, nonsteroidal anti-inflammatory drug (NSAID) and steroid use, duration before surgery, preoperative shock status, previous symptoms of peptic ulcer disease, smoking habits, and fasting status were evaluated, and significant correlations with postoperative complications were analyzed statistically. Results: A total of 100 patients aged 16–87 years were included in the study, and the male-to- female ratio was 3:1. Sixty-seven (67%) patients underwent surgery within 12 h after admission, 41% of patients had a history of chronic disease, 54% of patients had an ASA score of 1, 57% of patients were smokers, 45% of patients reported previous peptic ulcer symptoms, and 22% of patients had preoperative shock status. Thirty-seven (37%) patients developed postoperative complications, and 8% of patients died. Conclusion: This study confirmed that advanced age, a high ASA score, preoperative shock, comorbidities, and delayed presentation before surgery were all risk factors for postoperative complications and mortality in patients with perforated peptic ulcer disease. Habitual smoking, fasting status, and NSAID and steroid use were not correlated with mortality.

Association of Helicobacter Pylori with Peptic Ulcer Perforation

Background: Helicobacter pylori is found in more than 90% cases of peptic ulcer. This study examines the possibility of association of Helicobacter pylori in perforated peptic ulcer disease and its relation to persisting ulcer as well as the influence of other risk factors; namely: smoking, alcohol, current non-steroidal anti inflammatory drugs (NSAIDs) and steroid use.&#x0D; Materials and Methods: In this prospective study, total of 50 cases of peptic ulcer perforation admitted in College of Medical Sciences and Teaching Hospital, Bharatpur, Nepal were selected on the basis of the non-probability (purposive) sampling method. All patients who presented with suspected peptic ulcer perforation were included in the study and the perforations were repaired by Modified Graham’s Patch and were given triple therapy postoperatively. The age, sex, incidence, mode of presentation, precipitating factors, association with the risk factors and postoperative complications were all evaluated and compared.&#x0D; Results: Of 50 patients studied, the age ranged from 17 to 75 years, mean age being 40.1 years with the peak incidence in the 3rd and 5th decades of life showing a male dominance (92%). H. pylori was seen in ulcer edge biopsy in 29 patients (58%). Most common clinical presentation was pain abdomen, the most common signs of perforation were tenderness, rebound tenderness and absent bowel sounds. The mean duration of stay in hospital in H. pylori positive patients was 12.07±8.15 days as compared with 11.1±5.12 days in H. pylori negative patients. The incidence of peptic ulcer perforation was higher in the patients consuming alcohol (64%) than smokers (48%), followed by NSAIDs user(22%). 20% of the patients with delayed presentation developed complications postoperatively. Perforated peptic ulcer was repaired by Modified Graham’s Patch Repair, followed by anti H. pylori therapy in all of them.&#x0D; Conclusion: Peptic ulcer perforation is quite common among the patients with peptic ulcer disease with history of chronic smoking, alcoholism and analgesic intake, more commonly in males. There is association of H. pylori in 58% of patients with peptic ulcer perforation.

Role of Clinical Decision and Management of Patients Admitted with Perforated Peptic Ulcer to Damascus Hospital (Al Moujtahed), Damascus, Syria

As far as we know, there has been no previous published studies concerning the incidence of perforated peptic ulcer (stomach, duodenum) and its related risk factors in Syria, and their managements in association with the current Syrian conflict, that precipitated limited access to admitting such cases to over populated beds. This study addressing the burden shouldered by Health professionals, and aimed to determine the Prevalence of perforated peptic ulcer (PPU) in patients admitted to Damascus Hospital between 24/11/2015-4/11/2017, needless to mention also describe the values of making the diagnosis on clinical bases, and based on the principles that we are under the insult of our current dilemma namely civil conflict in Syria, precipitated shortening of all necessities to provide good and acceptable management with hope of achieving absolute cure.

A rare case of spontaneous gastric perforation in an adolescent

Incidence of Peptic ulcer perforation in children and adolescents are very rare. Perforated gastric ulcer is extremely rare with only handful of cases reported worldwide in the same age group. Pneumoperitoneum and peritonitis due to gastric perforation is a very rare presentation in children and adolescents and it can often be overlooked with disastrous consequences. Even though in young patients, peptic ulcerations can happen in association with H. pylori infection, secondary to medications like non-steroidal anti-inflammatory agents, corticosteroids, rarely due to Zollinger Ellison syndrome, related to stress, post burns or head trauma it is seldom common. Among perforations gastric perforation is very rare. Here we discuss a case of 15-year-old school student who presented with acute abdominal pain and features of peritonitis which we initially thought probably due to perforated appendix but turned out to be a gastric perforation. Plain radiograph of the abdomen showed pneumoperitoneum. When an emergency midline laparotomy was performed, we found a perforation in gastric antrum anteriorly with peritonitis which was treated by thorough decontamination and Graham's live omental patch closure. H. Pylori tests were negative. At a time when acute presentation of peptic ulcerations or perforation as its complication is decreasing in incidence worldwide, this case has come as an eye opener. Thus, perforated gastric/duodenal ulcer in pediatric and young adult patient should not be overlooked in a young patient presenting with acute abdomen. Many times, there is no clear etiology and then it is spontaneous perforation. Emergency surgical management is the preferred mode of treatment.

Study of Incidence of Peptic Ulcer Perforation in Young Adults: A Hospital Based Study

Background: Peptic ulcer formation affects about 2-10% of world population every year with higher incidence in younger individuals. Being a surgical emergency, it has higher mortality and morbidity. Thus, the aim of our study was to evaluate the incidence of peptic ulcer perforation based on gender, age and also to study its associated risk factors, clinical presentations, site along with surgical management and complications. Materials & Methods: 75 patients diagnosed with perforated peptic ulcer were included and this study was conducted in the department of Surgery Government Bangur Hospital, Pali, Rajasthan, India. Structured performa was prepared to obtained details of patients and ethical clearance from the institute was also taken prior to the study. Results: 76% of patients in our study were males and 24% were females with male and female ratio 1:3.16. The prevalence of perforation was high in age group 20-30 years (30.7%). 62.7% of cases had positive family history and the incidence was in the patients who consumed non-vegetarian (84.8%), spicy (61.4%) and oily (69.5%) foods. Frequently observed clinical presentation were abdominal pain followed by tenderness and rigidity and gas under diaphragm. The common site of perforation was duodenum (62.7%) and most of the cases were treated by closure with omental patch (81.3%). The post-surgical complications frequently observed were wound infection (30.6%) and chest infection (28%). Conclusion: Peptic ulcer perforation is common disorder of gastrointestinal tract, now affecting younger adults with male preponderance. It is associated with unwanted health and economic issues. Therefore, earlier management is only the way to minimize complications and mortality.

Effect of Ramadan Fasting Upon Perforated Peptic Ulcer Patients: A Descriptive Analysis

Background: Perforated peptic ulcer (PPU) is relatively rare, but life threatening with the mortality varying from 10% to 40%. While common causes of peptic ulcer disease are H. Pylori, increased inadvertent use of NSAIDS, smoking and stress of modern life, the specific etiologic agent cannot be incriminated in the causation of its perforation.Objective: The aim of this study is to evaluate the effect of perforated peptic ulcer in fasting Muslims.Methods: This prospective analysis was conducted for the risk factors associated with perforated peptic ulcer (PPU) in patients attending Surgical Emergency hospital &amp; Sulaimaniyah Teaching Hospital on 312 cases (246 male &amp; 66 females) during the period of one month before Ramadan (Shaban), holy Ramadan and one month after Ramadan (Shawal) for ten successive years from 2006 to 2015. Descriptive analysis and Chi square test was used to find an association between studying variables.Result: The number of PPU per month was higher in Ramadan, 16.6 patients per month vs. 7.3 patients per each other month and also high among group 1 fasting patients. Predisposing factors played a major role in these differences.Conclusion: This study found that the incidence of PPU is relatively high among people who have predisposing factors, including young adults age, but earlier in non-fasting people , male gender, but no difference between the two groups in those using non -steroidal anti-inflammatory drugs, history of dyspepsia. Those patients have previous peptic ulcer disease diagnosed on esophagogastroduodenoscopy more prone to perforation. Long period day after day fasting, but not daytime length duration may increase PPU.Recommendations: This study recommends that the people with these risk factors must be well informed and need special care to avoid such complications. This study also suggests further studies regarding this subject.

Preoperative factors influencing mortality and morbidity in peptic ulcer perforation.

Perforated peptic ulcer is one of the most common surgical emergencies worldwide. With the improvement in medical therapy for peptic ulcers, the number of elective surgical procedures has come down. However, the incidence of perforated peptic ulcer is still increasing and remains as a substantial health problem with significant postoperative morbidity and mortality. This study aimed to find out the association between various preoperative and intraoperative factors with the postoperative mortality and morbidity in patients operated for peptic ulcer perforation. This prospective observational study had a time based sample of 101 perforation peritonitis cases admitted to the surgical wards of a tertiary care center from February 2015 to January 2016 who underwent laparotomy, diagnosed to have peptic ulcer perforation and underwent simple closure with an omental patch. Data regarding age, gender, presenting complaints, time elapsed from the onset of symptoms to surgery, physical examination findings, comorbid diseases, laboratory and imaging findings, intraoperative findings, length of hospital stay, postoperative morbidity, and mortality were recorded and analyzed. Female gender, older age group, perforation surgery interval more than 36h, and size of perforation more than 1cm2 were found to be significant factors influencing postoperative mortality and morbidity. Postoperative morbidity was also associated with comorbid diseases. Abnormal renal function on presentation was identified as an additional risk factor for postoperative morbidity and longer hospital stay. An understanding of these factors, identification of patients at risk and early intervention can help in reducing the postoperative morbidity and mortality in peptic ulcer perforation.

Peptik ülser perforasyonunda mortalite ile ilişkili faktörlerin değerlendirilmesi: Retrospektif vaka-kontrol çalışması

Aim: Although there has been significant progress in current medical treatments for the treatment of peptic ulcer, there has been no change in the incidence of peptic ulcer perforation (PUP). PUP has an important place in urgent surgery due to mortality rates. In this study, it was aimed to determine the factors related to death related to PUP. Material and method: Observational type study was planned. Patients who underwent surgery due to PUP in 2009-2016 included to study. The number of samples was set at 225 to show 30% difference with a 5% α error at 90% safety interval. Twenty patients were added to reduce the error. Patients were screened for demographic data, presence of chronic disease (diabetes, cardiac), smoking status, nonsteroidal anti-inflammatory (NSAID) use, reference leukocyte level, complaint-to-intervention time and surgical site infection (SSI). The death in the perioperative period (first month) was determined as the main outcome parameter. Patients were divided into two groups according to the presence of death (Group 1: study group, Group 2: control group). Descriptive statistics, number, percentage, mean ± standard deviation, median (quartile range) were used for statistics. T-test, Mann-Whitney, Fisher's exact and Chi-square test were used for comparisons. A p value of less than 0.05 was considered significant at 95% safety interval. Results: 245 patients (group 1: 11 (4.5%), group 2: 234 (95.5%) were included in the study. The groups were divided into two groups according to sex (group 1: Male/Female=1,2, group 2: Male/Female=6,1) and age (group 1: 62,8±16,6, group 2: 40±16,8) The difference was detected (p=0.016, p=0.0001). Chronic cardiac diseases were more common in the study group (p=0.0001). There was no difference in the presence of diabetes, smoking, and NSAID use (p=0.092, p=0.624, p=0.214). Leukocyte levels were found to be low in the study group (group 1: 9 (10) thousand/mm3, group 2: 13 (6), p=0.032). Complaints-operation times were higher in the study group (group 1: 12 (14) hours, group 2: 4 (4), p=0.0001). All the patients were repaired by Graham Rapha and drained. The duration of post-operative stay was similar between the groups (group 1: 4 (5) days, group 2: 5 (2), p=0.443). SSI was more frequent in the study group (p=0.008). Conclusion: Patients with female gender, advanced age, and chronic heart disease should be more cautious due to the high mortality risk.

Surgical outcomes for perforated peptic ulcer: A prospective case series at an academic hospital in Monrovia, Liberia

Introduction The incidence of perforated peptic ulcer remains high in low and middle-income countries. Mortality can be significant, and early surgical management with careful evaluation of pre-operative risk factors is essential. The purpose of this study was to describe the clinical outcomes of surgical treatment for perforated peptic ulcer disease in Liberia and to explore risk factors for adverse outcomes. Methods This study prospectively examined 20 consecutive patients undergoing primary closure with omental patch for perforated pre-pyloric or duodenal peptic ulcer at the John F. Kennedy Medical Centre (JFKMC) in Monrovia, Liberia from May 2009 to March 2010. Pre-operative information was captured in a questionnaire. Risk factors were assessed for univariate and multivariate associations with in-hospital mortality. Results Median age was 33years and 85% were males. A majority of the patients (70%) had a history of gastritis and antacid use. Median time from beginning of symptoms to surgery was 4.5days. Over-all in-hospital mortality following surgical therapy for perforated peptic ulcer disease was 35%. Median length of stay among survivors was 16days, and death occurred at median 1day after admission. Long symptom duration and age >30years of age were significantly associated with in-hospital mortality on univariate ( β =2.60 [0.18–5.03], p =0.035) and multivariate testing ( β =2.95 [0.02–5.88], p =0.049). Conclusion Peptic ulcer disease and its treatment represent a potentially substantial source of morbidity and mortality in limited-resource settings. In this case series, surgical treatment for perforated peptic ulcer disease carried a high mortality, and the results highlight the potential for public health systems strengthening to prevent poor health outcomes. Peptic ulcer disease in low- and middle-income countries presents unique epidemiology and treatment challenges that may differ significantly from evidence-based guidelines in high-income countries.

Study of Laparoscopic Repair Versus Laparotomy In Management of Peptic Perforation Peritonitis

Introduction: Despite the widespread use of antisecretory agents and eradication therapy, the incidence of perforated peptic ulcer has changed little. Since the initial reports of successful laparoscopic management of perforated duodenal ulcers and perforation peritonitis several larger comparative series have been published confirming the technical feasibility and advantages of laparoscopic approach. Objectives: The aim is to compare the outcome and efficacy of laparoscopic repair with conventional laparotomy in the management of peptic perforation. Methods: The study was conducted on patients with diagnosis of peptic perforation in Hi-tech medical college and hospital, Bhubaneswar. It is a retrospective and prospective study from September 2012 to April 2014. Result: 50 patients of peroration peritonitis were operated randomly by laparoscopic repair and laparotomy. It was found that the laparoscopic repair of perforated peptic ulcer was associated with less intra operative blood loss, no intra operative complications, minimum post operative complications, minimum postoperative pain which was significant as compared to laparotomy repair. Conclusion: Laparoscopic repair of perforated peptic ulcer could be considered as a treatment option in routine clinical practice in the management of peptic perforation peritonitis.

Study of incidence of peptic ulcer perforation in young adults

Background: Peptic ulcer perforation is the commonest perforation of the gastrointestinal tract affecting 2-10% population showing a shift from older to the younger population. With this statistics a study for incidence of peptic ulcer perforation in young adults 18-30 years was carried out. Methods: Prospective study of patients admitted on emergency basis and diagnosed as peptic ulcer perforation either gastric or duodenal perforation intraoperatively in patients 18-30 years were studied from June 2009 to October 2011. Results: Of 175 patients, 70 (40%) patients were between 18 and 30 years age. 58 (82.85%) were males and 12 (17.14%) were females. Twenty-three (32.85%) patients had history suggestive of acute peptic disease/ulcer and had taken some treatment in the form of antacid H-2 blocker or proton pump inhibitor while 47 (67.14%) patients had no history. Pain was the consistent symptom while tachycardia, tenderness, and guarding were the signs present in all 70 (40%) patients. Gas under diaphragm (pneumoperitoneum) was found in 67 (95.71%). Ultrasonography abdomen S/O pyoperitoneum was found that all 70 (100%). 57 (81.42%) patients had an anterior duodenal perforation, 12 (17.14%) patients had a gastric perforation with a ratio of 4.7:1, and 1 patient had a combined gastric and duodenal perforation. 1 (2.43%) patient expired in the post-operative period, 55 (78.57%) patients come for regular follow and 14 (20%) patients were lost to follow-up. Only 4 (7.2%) patients had mild to moderate symptoms of peptic ulcer disease which were controlled by anti-ulcer drugs. Conclusion: Peptic ulcer perforation is a disease more common in the young population with a male preponderance.

Gastro-duodenal peptic ulcer perforation

To determine the epidemiology of, and define the morbidity and mortality factors following emergency surgery for patients with perforated peptic ulcer disease in Accra, Ghana. A retrospective and prospective hospital-based study. The general and paediatric surgical wards of the Korle-Bu Teaching Hospital. Demography, the systolic BP, pulse rate and haemoglobin on admission at ER, co-morbid conditions, site of perforation, surgical method and treatment outcome. A total of 326 cases treated for peptic ulcer perforation, 267 males and 59 females; ratio 4.5:1, with mean age of 40.9, SD 16.4 and range 4-87 years, were studied. The incidence of peptic ulcer perforation rose from 1.6% in 1998 to 5.3% in 2002 and stabilised at 5%, and overall accounted for 4.6% of acute abdomen. Co-morbid conditions were present in 48 (18.2%) of cases. Ulcerogenic substance intake was in 177 (67%) patients. One hundred and twenty two (46.2%) patients reported to hospital within 24 hours of perforation. There were 287 (88%) duodenal, 22 (7.1%) prepyloric, and 19(4.9%) type 1 gastric ulcer perforations. Simple closure with omental patch was performed in 299 (94.3%), truncal vagotomy and drainage in 10 (3.2%), and Billroth II partial gastrectomy in seven (2.2%). Post-operative complications occurred in 62 (19%); overall mortality was 36 (11%). Logistic regression analysis of the patients clinical variables showed that age less that 60 years (p-value, OR and 95% CI; 0.002, 3.964 and 1.668-9.420), duration of perforation of more than 24 hours before admission (p-value, OR and 95% CI; 0.011, 2.471 and 1.228-4.971), alcohol intake (p-value, OR and 95% CI; 0.009, 2.543 and 1.259-5.135) and resectional surgery (p-value, OR and 95% CI; 0.000, 8.25E and 74204908.138-9162648048.1) were statistically significant in determining postoperative complications. Age 60 years and above (p-value, OR and 95% CI; 0.018,4.359 and 1.284-14.802), alcohol intake (p-value, OR and 95% CI; 0.042, 3.238 and 1.046-10.021) and resectional surgery (p-value, OR and 95% CI; 0.000, 1.20E and 938112920.94-1.54E+ 11) were the factors that showed statistical significance in determining post-operative mortality. Perforated peptic ulcer disease is emerging as a frequent cause of acute abdomen in our centre and affects the youth commonly. Age 60 years and above, duration of perforation for more than 24 hours before admission, alcohol intake and resectional surgery were the variables that showed statistical significance in predicting post-operative morbidity and/or mortality.

Perforated Peptic Ulcer in South India: An Institutional Perspective

Perforated peptic ulcer is one of the most common surgical emergencies in South India. The advent of medical therapy for peptic ulcer has remarkably decreased the number of elective surgical procedures. The incidence of perforated peptic ulcer on the contrary, is increasing. The high incidence of complications necessitates the identification of factors associated with the morbidity and mortality of patients undergoing surgery for perforated peptic ulcer. Three hundred twenty-eight consecutive patients (299 men and 29 women) who underwent surgery for perforated peptic ulcer in our institute between November 2006 and June 2008 were studied prospectively. The mean age was 43.4 +/- 14.4 years. The mean hospital stay was 10.9 +/- 6.8 days. Of the 328 patients, 58 presented with shock, 159 presented with delay more than 24 h, and 24 had co-morbid illness. Wound infection and intra-abdominal abscess were encountered in 12.5% and 13.4% of the patients, respectively. Altogether, 85 patients had postoperative complications. Twenty-eight (8.5%) patients died. The mortality rate among men and women was 7.9% and 20.7%, respectively. Age > or = 60 years, lag period longer than 24 h, presence of co-morbid illness, and shock at presentation were identified as independent predictors of postoperative complications. Shock at presentation, presence of co-morbid illness, American Society of Anesthesiologists (ASA) grade III or more, and renal failure were identified as independent predictors of mortality. Decreasing the delay in intervention and improving access to medical care may improve the outcome of patients undergoing surgery for perforated peptic ulcer. High-risk patients are those who present with shock and co-morbid illness.

Perforated Peptic Ulcer: Different Ethnic, Climatic and Fasting Risk Factors for Morbidity in Al-Ain Medical District, United Arab Emirates

To evaluate risk factors, morbidity and mortality rates of perforated peptic ulcer (PPU) and to investigate factors affecting postoperative complications of PPU. The incidence of PPU has remained constant, simple closure with omental patch repair being the mainstay of treatment. One hundred and nineteen patients admitted to Al-Ain Hospital with PPU between January 2000 and March 2004 was studied retrospectively; two with deficient data were excluded from the analysis. Logistic regression was used to define factors affecting postoperative complications. The mean age of patients was 35.3 years (range, 20-65). 45.7% of patients were Bangladeshi, and 85.3% originated from the Indian subcontinent. One patient, subsequently found to have a perforated gastric cancer, died. In 116 patients, 26 complications were recorded in 20 patients (17.2%). Common risk factors for perforation were smoking, history of peptic ulcer disease (PUD) and use of non-steroidal anti-inflammatory drugs (NSAIDs). A significantly increased risk of perforation was evident during the daytime fasting month of Ramadan. An increase in the acute physiology and chronic health evaluation (APACHE) II score (p = 0.047) and a reduced white blood cell count (0.04) were highly significant for the prediction of postoperative complications. Patients with dyspeptic symptoms and a history of previous PUD should be considered for prophylactic treatment to prevent ulcer recurrence during prolonged daytime fasting in Ramadan, especially during the winter time.