Perforated peptic ulcer - an update

Abstract

Peptic ulcer disease (PUD) affects 4 million people worldwide annually. The incidence of PUD has been estimated at around 1.5% to 3%. Perforated peptic ulcer (PPU) is a serious complication of PUD and patients with PPU often present with acute abdomen that carries high risk for morbidity and mortality. The lifetime prevalence of perforation in patients with PUD is about 5%. PPU carries a mortality ranging from 1.3% to 20%. Thirty-day mortality rate reaching 20% and 90-d mortality rate of up to 30% have been reported. In this review we have summarized the current evidence on PPU to update readers. This literature review includes the most updated information such as common causes, clinical features, diagnostic methods, non-operative and operative management, post-operative complications and different scoring systems of PPU. With the advancement of medical technology, PUD can now be treated with medications instead of elective surgery. The classic triad of sudden onset of abdominal pain, tachycardia and abdominal rigidity is the hallmark of PPU. Erect chest radiograph may miss 15% of cases with air under the diaphragm in patients with bowel perforation. Early diagnosis, prompt resuscitation and urgent surgical intervention are essential to improve outcomes. Exploratory laparotomy and omental patch repair remains the gold standard. Laparoscopic surgery should be considered when expertise is available. Gastrectomy is recommended in patients with large or malignant ulcer.

Efficacy of Ayarij Faiqura in Qarah-e-Hazmiya - Randomized controlled Clinical study

“…Patients were divided into two groups of 20 in test and 8 in control group. The median VAS Score of burning sensation in abdomen in control group was 8 [8,8] on base line (0 day) and 3 [2,5] on 45th day, whereas in test group the median score was 8 [7,8] on baseline (0 day) and 0[0,3] on 45th day. When the median VAS Score of two groups were compared statistically using Friedman test with Dunn pair comparison test for intra-group comparison and Krushkall Wallis for inter group comparison, it was found that the median VAS Score at 30th and 45th day in control group was reduced significantly (P<0.01) when compared with median VAS Score0th day of control group.…”

Frailty of Boey Score in Ppu Mortality and Morbidity Prediction- A Prospective Study

“…[6,11,12,5] Buck and colleagues on the other hand expressed the meagre ability of Boey score in predicting mortality and morbidity status. [13] Their multicentre study also stated that the ASA score, and sepsis score were not able to provide convincing results in prognostication of patients.…”

Editorial

“…In a study of 601 patients and including 62 patients treated with gastric resection, they noted that outcomes of patients treated with gastric resection were found to be more inferior when compared to omental patch repair with mortality risk of 24.2% (8). Some of the reasons for this outcome may include:…”

“…The narrative on this treatment over a century later has not changed much. It still consists of primary closure of the perforation by sutures and a convenient tag of adjacent omentum on top of this (7,8). Although this may sound very simplistic, PPU still remains a life threatening condition with a high mortality of up to 40% which cannot be underestimated (9).…”

“…Although this may sound very simplistic, PPU still remains a life threatening condition with a high mortality of up to 40% which cannot be underestimated (9). Several recent studies advocate non operative intervention as a stop gap before definitive surgical intervention (8). The disadvantages of this intervention are the high rate of mortality in case of the treatment failure and the lack of the benefit of laparoscopy or laparotomy as a diagnostic tool in case the patient has gastric cancer (10).…”