Peptic ulcer perforation in young Indians the causation and the trend

Abstract

INTRODUCTIONPerforative peritonitis is one of the commonest surgical emergencies faced by surgeons all over India. 1,2 Of these peptic ulcer perforation is the commonest cause of peritonitis.3 These perforations are usually encountered in the first part of the duodenum anteriorly and in the pylorus of stomach. The occurrence of perforative peritonitis is associated with previous history of peptic ulceration in only few patients.The workup of peptic ulcer perforation includes x-ray abdomen, ultrasound, basic laboratory investigations and special investigation for Helicobacter pylori in places where facility is available. The role of contrast enhanced CTSCAN exists only in areas where diagnosis is doubtful. The only rational treatment of perforated peptic ulcer is surgical operation. The role of conservative treatment is in only sealed perforations with little contaminated fluid in the abdominal cavity with resolving pneumoperitoneum and hemodynamically stable patient. Simple closure of the perforation with non-absorbable suture material and graham's omentopexy using tongue of greater omentum are the procedures of choice. Vagotomy and highly selective vagotomy are the definitive procedures of choice; seldom attempted in emergency setting. Local bilateral flank drain placement is done in cases not fit for anesthesia and provides an interim management by drainage of the infected fluid ABSTRACT Background: Peptic ulcer perforation is the commonest surgical emergencies in India. Recent emergency surgical procedures show an increasing trend in peptic ulcer perforation surgery in young adults. This study is carried out with an aim to understand the trend, causation and complications of peptic ulcer perforation in young Indians. Methods: A prospective observational study of young adult Indian patients operated for emergency peptic ulcer perforation for a 3 years period from January 2014 to January 2017 was carried out. The incidence, causative factors and the complications were analyzed. Results: In study of 150 patients, maximum incidence of 42.85% was seen in age group of 21 to 30 years that is young adults. 80% of them were males. 59% patients had blood group O. Association with smoking and alcoholism was seen in about 64% and 66.6% respectively. In about 13.33% there was an association seen with history of NSAID / steroid ingestion / treatment with proton pump inhibitors or H2antagonists.The duodenal perforation was found in 84.66%. In 90% the perforation was less than 1cm.Wound infection was the commonest complication among all patients. Mortality was seen in 3.33%. Conclusions: Peptic ulcer perforation shows increasing incidence in young adult males. The increased incidence shows association to smoking, alcoholism, irregular food habits, use of NSAIDS/steroids and overall stressed lifestyle.

Spectrum of perforated peptic ulcer disease in a tertiary care hospital in South India: predictors of morbidity and mortality

“…The male: female ratio in our study was 24:1 and previous similar studies from India also show that more than 80% of patients with peptic ulcer perforation are males 2,4,7 . Males are more likely to smoke and constituted 121 out of 123 patients with significant smoking history in our study.…”

“…[1][2][3] Surgical repair of perforation with omental patch closure is the mainstay of treatment while conservative management is reserved only for select patients with sealed perforations, resolving pneumoperitoneum and stable hemodynamics. 4 Despite advances in the understanding and perioperative care, the mortality (3%-40%) and morbidity (20%-50%) associated with perforated peptic ulcer remain high. 5,6 Over the past two decades multiple studies have identified risk factors which significantly influence the post-operative recovery in patients with perforated peptic ulcer.…”

“…11 Although literature has many studies on perforated peptic ulcer, it is also imperative to periodically evaluate the risk factors for morbidity and mortality in peptic ulcer perforation. [1][2][3][4][5] Understanding the changes in the natural history, presentation or identification of new risk factors can help in further reducing the current mortality or morbidity rates in perforated peptic ulcer disease. Comparison of this data with existing literature adds to the understanding of evolution of the disease over the years.…”

“…Peptic ulcer disease (PUD) resulting in perforation peritonitis is one of the most common surgical emergencies in India 1–3 . Surgical repair of perforation with omental patch closure is the mainstay of treatment while conservative management is reserved only for select patients with sealed perforations, resolving pneumoperitoneum and stable hemodynamics 4 . Despite advances in the understanding and perioperative care, the mortality (3%–40%) and morbidity (20%–50%) associated with perforated peptic ulcer remain high 5,6 …”

Factors associated with anatomical patterns of peptic ulcer perforations in a low income country: a multicenter cross sectional study

“…Scholars attribute male over representation to high alcohol consumption rates and cigarette smoking (15). Researchers in Ethiopia found that men were more likely to smoke, drink alcohol and use NSAIDS but what drives this behavior other than psychosocial stress is documented (17).…”