Perforated Duodenal Ulcer: Has Anything Changed?

Koskensalo, Selja; Leppäniemi, Ari

doi:10.1007/s00068-010-9128-7

Cited by 8 publications

(5 citation statements)

References 23 publications

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“…The diagnosis of PUP is most often made using the initial plain abdominal X-ray (15)(16)(17). In our study, 98 (87.5%) patients were diagnosed using the initial plain abdominal X-ray.…”

Section: Discussionmentioning

confidence: 65%

Is it possible to reduce the surgical mortality and morbidity of peptic ulcer perforations?

Hut

Tatar²,

Dogan

et al. 2017

Turk J Surg

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INTRODUCTIONWith regard to creating a novel vision for former diseases, our memorizationsshould be updated. Some diseases and their outcomes, which have been previously very well known, are nowadays almost always presented as unexpected cases because of new technologies and evolvements in medicine due to resistant events. Thus, antiulcer medication and presentation of elderly patients have changed in peptic ulcer perforation (PUP) and, transforming the patient profiles with PUP in our era. Therefore, a novel vision to avoid gaps is necessary to evaluate the patients with PUPsas surgeons are coming across newer patient profiles in last decades. Peptic ulcers are focal defects in the stomach and the duodenum extending below the mucosa or deeper (1, 2). They can be acute or chronic; the etiology of the condition is the disruption of balance between gastric acid effect and mucosal defense mechanisms (2, 3). Although medical treatments such as H2 receptor antagonists, proton pump inhibitors, and Helicobacter pylori eradication through antibacterial drugs, have decreased the number of surgeries in non-complicated peptic ulcer cases, the number of patients presenting to the emergency clinics with peptic ulcer perforation has not decreased (1-5).Peptic ulcer perforation is still an important health problem, despite the decreasing incidence of peptic ulcer disease. The aim of this study was to investigate factors affecting the mortality and morbidity of PUPs and specifically determine approaches to decrease mortality. MATERIAL AND METHODSThe data from 112 patients operated with the diagnosis of PUP at our Training and Research Hospital between January 2010 and December 2015 were retrospectively analyzed. Patient age, gender, weight, height, American Society of Anesthesiologists (ASA) score, symptoms, time interval between symptom onset and surgery, accompanying diseases, length of hospital stay, operative technique, laboratory findings, site and diameter of perforation, Acute Physiology and Chronic Health Evaluation (APACHE) II and Mannheim Peritonitis Index (MPI) scores, preoperative shock state, morbidity, and mortality were recorded. MPI (Table 1) and APACHE II scores were calculated for all patients. Patient age, chronic health status, rectal temperature, mean arterial blood pressure, heart rate, respiratory rate, arterial pH, partial oxygen pressure, serum sodium, serum potassium, serum creatinine, hematocrit, white blood cell count, and Glasgow coma score were recorded for determining the APACHE II score. 267Objective: Peptic ulcer perforation is a life-threatening situation requiring urgent surgical treatment. A novel vision in peptic ulcer perforation is necessary to fill the gaps created by antiulcer medication, aging of the patients, and presentation of resistant cases in our era. In this study, we aimed to share our findings regarding the effects of various risk factors and operative techniques on the mortality and morbidity of patients with peptic ulcer perforation. Material and Methods:Data from 112 patient...

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“…The diagnosis of PUP is most often made using the initial plain abdominal X-ray (15)(16)(17). In our study, 98 (87.5%) patients were diagnosed using the initial plain abdominal X-ray.…”

Section: Discussionmentioning

confidence: 65%

Is it possible to reduce the surgical mortality and morbidity of peptic ulcer perforations?

Hut

Tatar²,

Dogan

et al. 2017

Turk J Surg

View full text Add to dashboard Cite

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“…Duodenal fistulas are rare and occur in 2–7% after repair of perforated peptic ulcer, in about 4% in associated with severe acute pancreatitis, 3% after gastrectomy for gastric cancer and 1% after endoscopic retrograde cholangio-pancreatography (ERCP) [ 20 – 23 ]. The main controversy regarding the management of postoperative duodenal fistulas is between initial surgical or nonoperative management, and as shown in Table 1 , the successful fistula closure rates in series with more than 10 patients vary from 62 to 100%.…”

Section: Discussionmentioning

confidence: 99%

Complex duodenal fistulae: a surgical nightmare

2023

Self Cite

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Introduction A common feature of external duodenal fistulae is the devastating effect of the duodenal content rich in bile and pancreatic juice on nearby tissues with therapy-resistant local and systemic complications. This study analyzes the results of different management options with emphasis on successful fistula closure rates. Methods A retrospective single academic center study of adult patients treated for complex duodenal fistulas over a 17-year period with descriptive and univariate analyses was performed. Results Fifty patients were identified. First line treatment was surgical in 38 (76%) cases and consisted of resuture or resection with anastomosis combined with duodenal decompression and periduodenal drainage in 36 cases, rectus muscle patch, and surgical decompression with T-tube in one each. Fistula closure rate was 29/38 (76%). In 12 cases, the initial management was nonoperative with or without percutaneous drainage. The fistula was closed without surgery in 5/6 patients (1 patient died with persistent fistula). Among the remaining 6 patients eventually operated, fistula closure was achieved in 4 cases. There was no difference in successful fistula closure rates among initially operatively versus nonoperatively managed patients (29/38 vs. 9/12, p = 1.000). However, when considering eventually failed nonoperative management in 7/12 patients, there was a significant difference in the fistula closure rate (29/38 vs. 5/12, p = 0.036). The overall in-hospital mortality rate was 20/50 (40%). Conclusions Surgical closure combined with duodenal decompression in complex duodenal leaks offers the best chance of successful outcome. In selected cases, nonoperative management can be tried, accepting that some patients may require surgery later.

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“…They can develop in a notable proportion of patients who have undergone surgical repair for perforated peptic ulcers, with a reported occurrence ranging from 2% to 7%. Moreover, they are present in approximately 4% of cases of severe acute pancreatitis, 3% after gastrectomy for gastric cancer, and 1% following the diagnostic procedure called endoscopic retrograde cholangiopancreatography (ERCP) [3][4][5][6].…”

Section: Introductionmentioning

confidence: 99%

Reno-Duodenal Fistula as a Complication of Staghorn Stones and Renal Pelvis Tumor: A Case Presentation

Alnefaie,

Alsolumany,

Aljahdali

et al. 2024

Cureus

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Reno alimentary fistula, a rare illness characterized by improper connection between the kidney and digestive tract, can lead to urinary tract infections, abscesses, and severe sepsis. It can also be caused by various factors such as chronic infections, malignancy, cryoablation, or abdominal surgical procedures. We present a case of a 60-year-old man with bilateral staghorn stones who was diagnosed with reno-duodenal fistula and underwent a right simple nephrectomy and fistula closure. The histopathology revealed a well-differentiated squamous cell carcinoma that originated from the renal pelvis.

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Perforated Duodenal Ulcer: Has Anything Changed?

Cited by 8 publications

References 23 publications

Is it possible to reduce the surgical mortality and morbidity of peptic ulcer perforations?

Is it possible to reduce the surgical mortality and morbidity of peptic ulcer perforations?

Complex duodenal fistulae: a surgical nightmare

Reno-Duodenal Fistula as a Complication of Staghorn Stones and Renal Pelvis Tumor: A Case Presentation

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