Perforated Duodenal Ulcer Research Articles

Laparoscopic Versus Open Closure of Duodenal Perforations: A Retrospective Comparative Study in a Rural Hospital, Andhra Pradesh, India

Abstract Introduction: Evidence on the outcomes of laparoscopic surgeries, especially in emergency conditions such as peptic ulcer, remains unknown. A retrospective study was conducted in a rural surgical unit in Andhra Pradesh to compare morbidity, mortality, and duration of hospital admission in patients undergoing laparoscopic (Group L) and open (Group O) closure of duodenal perforations. Methods: Retrospective data of adult patients with peptic ulcer perforation treated by surgical approach during January 2012 and December 2017 were scrutinized. Pre- and postoperative records were abstracted for clinical conditions. Mortality was compared between the two groups with appropriate statistical tests. Results: A total of 120 patients, 60 in each group, were recruited for the study. The preoperative clinical characteristics of the two groups were similar. The mean duration of surgery was significantly higher in Group L (212.8 ± 29 min) compared to Group O (107 ± 16 min) (P < 0.001). Wound discharge (n = 3, 5%) and postoperative leak (n = 2, 3.3%) were the only complications noted in the L group. Several complications were noted in the O group including wound discharge (n = 51, 85%), wound dehiscence (n = 12, 20.0%), postoperative leak (n = 8, 13.3%), pneumonia (n = 1, 1.7%), and need for ventilation (n = 6, 10.0%). Three (5%) patients died in the hospital in Group O while none died in Group L. The average duration of hospital admission was 7.1 days (standard deviation [SD] =1.0 days) for Group L and 11.7 days (SD = 2.2 days) for Group O (mean difference: 4.6 days; 95% confidence interval: 4.6–5.2 days). Conclusion: Laparoscopic correction of duodenal ulcer perforation is both feasible and effective in reducing morbidity and mortality and overall treatment duration at peripheral centers.

OUTCOME OF GRAHAM PATCH OMENTOPEXY IN THE MANAGEMENT OF PERFORATED DUODENAL ULCER

Perforated duodenal ulcer remains a surgical emergency with significant morbidity and mortality. Graham’s patch omentopexy is a commonly performed procedure for its management. Evaluating the outcomes of this technique is crucial for improving patient care. Objective: To examine the outcomes of Graham’s patch omentopexy in managing perforated duodenal ulcers, focusing on postoperative complications. Methods: This study included 45 patients diagnosed with perforated duodenal ulcers who underwent Graham’s patch omentopexy from June 2023 to December 2023. The outcomes were assessed in terms of postoperative complications, including wound infection, wound dehiscence, pneumonia, bile leakage, abdominal abscess, and mortality. Results: The mean age of the patients was 46.49 ± 9.58 years. Postoperative complications included wound infection in 14 patients (31.3%), wound dehiscence in 13 patients (28.9%), pneumonia in 6 patients (13.3%), bile leakage in 5 patients (11.1%), abdominal abscess in 6 patients (13.3%), and mortality in 1 patient (2.2%). Conclusion: Graham’s patch omentopexy is an effective technique for managing perforated duodenal ulcers; however, complications such as wound infection, dehiscence, pneumonia, bile leakage, abdominal abscess, and mortality can occur. Further studies are needed to identify factors associated with these complications to optimize patient outcomes.

Frequency of Surgical Site Infection (SSI) between laparoscopic graham's omentopexy and open graham's omentopexy after duodenal ulcer perforation.

Objective: To compare frequency of surgical site infection between laparoscopic Graham's omentopexy and open Graham's omentopexy after duodenal ulcer perforation. Study Design: Randomized Controlled Trial. Setting: Department of Surgery, Allied Hospital, Faisalabad. Period: 31st October 2020 to 30th April 2021. Methods: A total of 86 patients with perforated duodenal ulcer, 25 to 60 years of age, were included. Laparoscopic Graham's omentopexy was done in Group A patients while open Graham's omentopexy repair was done in Group B patients. A dose of broad-spectrum antibiotic was given prior to anesthesia. After surgery, all patients were followed up for two weeks to assess the surgical site infection. Results: From 86 patients, 59 (68.60%) were males and 27 (31.40%) were females. Our study has shown the surgical site infection in group A (laparoscopic Graham's omentopexy) as 01 (2.33%) and in group B (open Graham's omentopexy) as 11 (25.58%) respectively, with a p-value of 0.002. Conclusion: Our findings show that the surgical site infection is less after laparoscopic Graham's omentopexy as compared to open Graham's omentopexy for duodenal ulcer perforation.

Perforated duodenal ulcer after Roux-en-Y gastric bypass: an unusual complication.

Bariatric surgery is increasingly being accepted as a viable treatment for managing the growing obesity epidemic. Roux-en-Y gastric bypass (RYGB) is one of the most commonly performed procedures. Perforated duodenal ulcer following RYGB is a rare condition with a low incidence. We report a case of a patient with a perforated duodenal ulcer post RYGB, and the surgical approach. A 66-year-old man with hypertension and a history of laparoscopic RYGB for class III obesity was admitted to the emergency department with severe epigastric pain radiating to the right side of his abdomen and right shoulder, associated with nausea and vomiting. Computed tomography (CT) showed intraperitoneal free fluid, a thickened wall of the duodenum and free air, duodenal perforation was suspected. The patient underwent exploratory laparoscopy that revealed a perforated duodenal ulcer that was closed with an absorbable barbed suture and omental patch. Perforated ulcers in excluded segments after RYGB are a rare entity with a challenging diagnosis, and clinicians should be aware of and have a low threshold for diagnostic laparoscopy. Roux-en-Y gastric bypass (RYGB) is one of the most commonly performed procedures in bariatric surgery. Perforated ulcers in excluded segments after RYGB are a rare entity with a challenging diagnosis. The pathophysiology of this perforation is not clear, but several mechanisms have been proposed. Helicobacter pylori has been implicated. Clinicians should be aware and have a low threshold for diagnostic laparoscopy for a patient who has acute abdominal pain after RYGB, despite negative diagnostic measures.

Immediate Postoperative Outcome of Peritoneal Lavage with Povidone-Iodine Based Normal Saline Versus Normal Saline in Duodenal Ulcer Perforation

Immediate Postoperative Outcome of Peritoneal Lavage with Povidone-Iodine Based Normal Saline Versus Normal Saline in Duodenal Ulcer Perforation

Особливості виникнення поширеного перитоніту та вплив поліморфізму гена 5,10-метилентетрагідрофолатредуктази

It is relevant in modern surgery to clarify the risk factors of widespread peritonitis and to improve the treatment and diagnostic algorithms for the management of such patients. Aim - to establish the features of the occurrence of widespread peritonitis and the influence of MTHFR gene polymorphisms on the risk of its occurrence. Materials and methods. The study included 100 patients who underwent surgical interventions for acute abdominal diseases complicated by peritonitis: acute appendicitis (48%), acute cholecystitis (32%), perforated ulcer of the stomach or duodenum (8%), tumor perforation (3%), injuries of the abdominal cavity (3%), pinched hernia (2%) and intestinal obstruction (4%). Genotypes of MTHFR gene polymorphisms rs1801131 and rs1801133 were determined by real-time polymerase chain reaction. Mathematical processing of the research results was carried out using the Statistica 10 program. Results. The risk of disseminated peritonitis was increased with perforated gastric or duodenal ulcer, tumor perforation, abdominal trauma, herniated hernia, or intestinal obstruction compared with acute appendicitis and cholecystitis. The risk of disseminated peritonitis was lower in II blood group carriers compared and was associated with temperature at hospitalization and pulse rate. Conclusions. The factors determining the risk of disseminated peritonitis in the multivariate regression model were the diagnosis, heart rate, and the rs1801131 genotype of the MTHFR gene. The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of the participating institution. The informed consent of the patient was obtained for conducting the studies. No conflict of interests was declared by the authors.

AB135. SOH24AB_111. Single centre experience with managing perforated duodenal ulcer between 2017 and 2021

AB135. SOH24AB_111. Single centre experience with managing perforated duodenal ulcer between 2017 and 2021

Endoscopic repair of a perforated duodenal ulcer: time to close the gap

Video 1Management of an acute perforated duodenal ulcer.

POSSIBILITIES OF TREATING PERFORMATIVE ULCERS OF THE STOMACH AND DUODENUM BY MEANS OF ENDOVIDEOSURGERY

The article presents the results of treatment of gastric and duodenal ulcer perforation and its complications in 35 children aged 12 to 18 years. Cases of videolaparoscopic removal of gastric and duodenal ulcers performed in these patientsIn 27 (77.2%) cases, it was successfully completed, and in 3 (8.6%) cases, conversion occurred. Traditional "open" surgical interventions were performed in 5 (14.2%) patients. The information content of ultrasound and X-ray methods of preoperative diagnosis was evaluated. In particular, the specific course of the disease and the results of diagnosis and treatment of the clinical manifestations of the studied disease were analyzed. A comparative analysis of videolaparoscopic and "open" surgical interventions for perforated ulcers of the stomach and duodenum was conducted.

Conventional versus enhanced recovery after surgery protocols in emergency gastrointestinal tract surgery: a randomized clinical trial

Background Compared with elective operations, emergency abdominal surgery is more likely to result in perioperative morbidity and mortality. Implementation of care programs could be beneficial for such patients to decrease complication rates. Enhanced recovery after surgery (ERAS) is a complex perioperative approach that has proven its efficacy in multiple elective procedures. Nonetheless, its efficacy in emergency abdominal surgery has been questioned. Herein, we compared the ERAS and conventional approaches in the management of such patients. Patients and methods Sixty adult patients were enrolled in our randomized prospective trial, and they were assigned to two groups; the conventional and ERAS groups. The duration of hospitalization was the main outcome. Results Preoperative characteristics, presentation, and surgical operations were comparable between the two study groups. A perforated duodenal ulcer was the most common diagnosis and was treated by through and through suture with the omental patch (36%) followed by resection anastomosis (36%) in patients with ischemic loop or patients with severely injured loops, and primary repair in simple injury (28%). The hospitalization period decreased significantly in ERAS patients (5.9 vs. 10.5 days in the conventional group P<0.001). The ERAS protocol had a significant beneficial impact on postoperative recovery, which manifested in earlier nasogastric tube removal, drain removal, bowel sounds, bowel motion, and oral intake compared with the conventional group. The incidence of postoperative complications especially surgical site infection increased significantly with the conventional perioperative regimen (36.7% vs. 13.3% after ERAS P=0.034). Conclusion ERAS has multiple advantages over the conventional approach when implemented in emergency surgery patients and is recommended in emergency surgical practice.

A very rare cause of acute abdomen in children: Peptic or duodenal ulcer perforations

A very rare cause of acute abdomen in children: Peptic or duodenal ulcer perforations

Retroperitoneal Abscess as an Extension of Ischiorectal Abscess: A Rare Case Report

Infections of the retroperitoneum can result from primary haematogenous spread of microbes or secondary infections originating from the retroperitoneal area or nearby organs. These abscesses can be caused by a perforated retrocaecal appendix, diverticulitis, perforated duodenal ulcers, iatrogenic gastrointestinal tract perforations, pancreatic cancer, inflammatory bowel diseases, genitourinary extravasation due to obstruction, osteomyelitis, postoperative duodenal ulcer perforations, and infections related to pelvic and puerperal conditions, as well as trauma. However, the occurrence of a retroperitoneal abscess as an extension of an ischiorectal abscess is exceedingly rare. Hereby, the authors present a case report of 27-year-old male who presented with persistent lower right quadrant abdominal pain, high-grade fever, and pus discharge from the perianal region for the last five days. He experienced difficulty passing stools and flatus for three days. Contrast-enhanced Computed Tomography (CECT) revealed a perforated appendix with fluid collection in the preperitoneal space on the right-side. Surgery revealed a significant amount of purulent discharge below the rectus muscle, extending along the right abdomen to the psoas muscle and connecting with the ischiorectal fossa. Retroperitoneal abscesses can originate from the perianal or ischiorectal region through various anatomical spaces.

PREVALENCE OF H. PYLORI INFECTION IN PATIENTS PRESENTING WITH PERFORATED DUODENAL ULCER

A cross-sectional study was conducted at the Department of Gastroenterology Qazi Hussein Ahmad Medical Complex, Nowshera, from January 2020 to January 2022 to determine the prevalence of H-pylori infection in patients with a perforated duodenal ulcer. A total of 189 patients were enrolled in the study. The data was analyzed using SPSS version 19 statistical software. Categorical data was computed as frequency and percentages and mean ± SD was used for all numerical variables. Out of the 189 patients, 115 (60.85%) were male and had an average age of 43.70 ± 7.38, and 74 (39.15%) were female and had an average age of 45.72 ± 8.85. The study revealed that 98 (51.85%) patients tested positive for H. Pylori stool antigen, while 91 (48.15%) tested negative. Based on the findings, patients with a perforated duodenal ulcer are more likely to have an infection with Helicobacter pylori. Therefore, it is crucial to conduct a thorough examination of such cases. Early diagnosis and treatment of H-pylori infection can prevent harmful consequences for the patient.

Early Enteral Nutrition Support Combined with Health Education Improves Quality of Rehabilitation After Repair of Acute Perforation of Duodenal Ulcers

Acute perforation is a severe life-threatening complication of duodenal ulcers. During perforation repair surgery, it is necessary to provide patients with enteral nutrition support to ensure their life safety. Herein, we developed and administered a health education form targeted at patients undergoing early enteral nutrition after duodenal ulcer surgery to help them manage the pains associated with enteral nutrition infusion. We found that patients in the research group who received health education combined with early enteral nutrition support had better nutritional status and a significantly reduced risk of malnutrition than patients in the control group after the treatment. Furthermore, patients in the research group had a significantly improved understanding of enteral nutrition support than patients in the control group. However, no significant difference was observed between the groups based on the recovery process and the incidence of adverse reactions. In conclusion, health education combined with early enteral nutrition support can substantially improve the nutritional status of patients and enhance their recovery after the repair of acute perforation of duodenal ulcers.

Assessment of the condition severity and prediction of postoperative complications in elderly and senile patients with perforated gastric and duodenal ulcer

Aim. To assess the condition severity and predict postoperative complications and mortality in elderly and senile patients with perforated gastric and duodenal ulcer using the P-POSSUM score. Materials and methods. To conduct a scientific study, 80 (100.0 %) cases of treatment for patients aged 60 to 89 years with a diagnosis of gastric or duodenal ulcer perforation were analyzed. At the stage of hospitalization, the general condition was assessed using the variables of the P-POSSUM score. All patients underwent emergency surgery. Results. The obtained sum of points was compared with postoperative complications and mortality. We defined the discrimination point as >43 points for postoperative complications and >48 points for mortality. Based on the result, the patients were divided into group A with a sum of points up to 43 inclusive – 39 patients (48.8 %), and with a greater number of points – 41 patients (51.2 %) – group B. Evaluation of the detected complications in the postoperative period and comparison with the sum of points significantly confirmed an increase in their frequency in group B (sum of points >43) as compared to group A (sum of points ≤43) – p = 0.0018, U = 474.0. To compare the mortality rate, all the patients were divided into group C – 48 (60.0 %) patients with a sum of points ≤48, and group D – 32 patients (40.0 %) with a sum of points ≥49. In the group of patients with a total score >48 (group D), the mortality rate was significantly increased compared to group C with a score ≤48, p = 0.0002, U = 384.0. Conclusions. Our study has led to the following conclusions: the P-POSSUM score use in elderly and senile patients with perforated gastric and duodenal ulcers significantly confirms the increase in the frequency of postoperative complications, in group A – 6 (15.4 %) patients, while in group B – 23 (56.1 %), p = 0.0018, U = 474.0 and increased mortality, in group C – 6.3 %, in group D – 56.3 %, p = 0.0002, U = 384.0; the P-POSSUM score provides reliable prediction an increase in the risk of postoperative complications and mortality. This, in turn, makes it possible to predict and change treatment approaches and improve the quality of emergency surgical care for elderly and senile patients.

METHODS FOR CLOSING PERFORATIONS OF GASTRIC AND DUODENAL ULCERS

This literature-based review analyzes different methods of closure of perforated gastric and duodenal ulcers. In addition, there have been determined the indications for the use of each method, the technique of performing, the advantages and disadvantages, as well as the prospects for use and their feasibility at the current level of abdominal surgery development.

ASPECTS DIAGNOSTIQUES ET THERAPEUTIQUES DES PERFORATIONS DIGESTIVES NON TRAUMATIQUES AU CENTRE HOSPITALIER UNIVERSITAIRE DE LIBREVILLE

Introduction: Non-traumatic digestive perforations are digestive surgical emergencies. They are usually considered perforations in free peritoneum. The objective of this work is to study the epidemiological, diagnostic and therapeutic aspects of non-traumatic digestive perforations at the Visceral Surgery Department of the Libreville University Hospital. Patients and method: Retrospective study of patients hospitalized and operated on at the Visceral Surgery Department of the Libreville University Hospital from January 2016 to December 2020 for non-traumatic digestive perforations. Epidemiological, etiological and therapeutic data were studied Results: They represented 14.1% of digestive surgical emergencies. The average age of the patients was 34±13.7 years [16-70 years]. the sex ratio was equal to 2.3. Intraoperatively, duodenal perforations were found in 48.1% of patients (n=37). Among the perforations of the small intestine, 4 were probably of typhoid origin (5.1%). The only colonic perforation was of tumor origin. In case of perforation of duodenal ulcer, suture associated with omental plasty was performed. An appendectomy was performed in all patients with appendiceal perforation. Overall operative morbidity was 3.9%. Mortality was 1.3% (n=1). The average length of hospitalization was 8.3 days. Conclusion: Non-traumatic digestive perforations are frequent digestive surgical emergencies, occurring at all ages, especially in men. The etiologies are numerous. The surgical procedure depends on the etiology.

Successful treatment of esophageal perforation due to black esophagus (acute esophageal necrosis): a case report

BackgroundBlack esophagus, or acute esophageal necrosis (AEN), is a rare disease with a poor prognosis in which the esophageal mucosa is black in color. We report a case of esophageal perforation due to AEN that was successfully treated.Case presentationAn 88-year-old woman presented to her local hospital with the chief complaint of abdominal pain. Endoscopic and radiological examinations revealed esophageal perforation due to AEN and duodenal perforation. Omental patch repair was performed for the esophageal perforation, and the duodenal ulcer perforation was treated by simple closure and gastrojejunostomy at the local hospital. Following refractory esophageal and duodenal perforations after the initial surgery, the patient was transferred to our hospital where emergent surgery was performed, comprising thoracoscopic esophagectomy, cervical esophagostomy, T-tube drainage, and omentopexy for duodenal perforation, as well as thoracic and abdominal drainage. Mucosal regeneration of the esophagostomy was confirmed endoscopically on postoperative day 19.ConclusionsAppropriate surgical intervention may be an optimal option in patients with esophageal perforation due to AEN.

Retrospective comparison of outcomes of patients undergoing omental patch versus falciform patch repair of perforated peptic ulcers.

The omental patch repair is the gold standard for the repair of perforated peptic ulcers. This can be performed open or laparoscopically. However, in the event of non-viable or inadequate omentum available at the time of surgery the falciform ligament has been reportedly used to as an alternative. Nonetheless, evidence for its safety is scant. This study aims to determine differences in patient outcomes when comparing the two repair techniques. Following ethics approval, patients who underwent surgical repair of perforated peptic ulcers using omental or falciform patch repair, between 1 January 2010 and 31 December 2017, across all three Western Australian tertiary hospital services and at least 18 years of age were included. Data were collected by reviewing medical records of included patients. Three hundred twenty-nine patients who underwent either open or laparoscopic repairs were included. Thirty-seven patients had falciform repairs and were mostly ASA of 2 compared to 292 patients receiving omental patch repair who were mostly ASA 3. Falciform patch repairs were more commonly used in duodenal ulcer perforations. There were no statistically significant differences in patient outcomes between the omental patch and falciform ligament groups. This included post-operative intra-abdominal sepsis, return to theatre, post-operative ICU admission, inpatient mortality, 30-day readmission and ulcer healing on follow-up gastroscopy. This study demonstrates safety, efficacy and similar outcomes for patients receiving the falciform ligament patch repair compared with omental patch repair.

Concurrent laparoscopic highly selective vagotomy with closure of duodenal ulcer perforations show good clinical results as primary repair alone.

To compare clinical and operative results between laparoscopic primary repair (LPR) alone and LPR with highly selective vagotomy (LPR-HSV) in patients with duodenal ulcer perforation. Clinical data from patients who underwent either LPR or LPR-HSV by resecting both sides of the neurovascular bundle using an ultrasonic or bipolar electrosurgical device for duodenal ulcer perforations, between 2010 and 2020, were retrospectively collected. Between-group differences in continuous and categorical variables were statistically analysed. Data from 184 patients (mean age, 49.6 years), who underwent either LPR (n = 132) or LPR-HSV (n = 52) were included. The mean operation time was significantly longer in the LPR-HSV group (116.5 ± 39.8 min) than in the LPR group (91.2 ± 33.3 min). Hospital stay was significantly shorter in the LPR-HSV group (8.6 ± 2.6 days) versus the LPR group (11.3 ± 7.1 days). The mean postoperative day of starting soft fluid diet was also significantly shorter in the LPR-HSV group (4.5 ± 1.4 days) than in the LPR group (5.6 ± 4 days). No between-group difference in morbidity rate was observed. The learning curve of the HSV procedure showed a stable procedure time after 10 operations. LPR with HSV may be a safe and feasible procedure for selective cases who are at high risk for ulcer recurrence.