Perforated Peptic Ulcer in South India: An Institutional Perspective

Arveen, Sankar; Jagdish, S; Dharanipragada, Kadambari

doi:10.1007/s00268-009-0056-9

Cited by 34 publications

(75 citation statements)

References 31 publications

(34 reference statements)

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“…The difference was not statistically significant. Similar seasonality was observed in India and Hong Kong, where perforations occurred most often in November-February [12]. This is inconsistent with the data regarding occurrence of PPU gathered in Cracow in the period 1991-1995, where an increased number of cases was observed in spring/summer months (May-July) and early autumn (September-October).…”

Section: Discussioncontrasting

confidence: 52%

“…This reflects data from the literature. The complication rate reported in publications ranged from 15% to 31.5% [10,12,25,30,32]. The most commonly report-ed complication was wound infection, occurring in 3-18.5% of patients [18,33].…”

Section: Discussionmentioning

confidence: 99%

“…However, the number of operations performed for PPU increased -during the study period we operated on 8 patients annually on average. At present most patients operated on for PPU are male [8,10,12]. Recently a growing number of perforations has been observed in elderly subjects, women in particular [6,13].…”

Section: Discussionmentioning

confidence: 99%

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Results of surgical treatment of perforated peptic ulcer

Tarnowski¹,

Bielecki²,

Kamiński³

et al. 2011

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Introduction: Effective treatment with H 2 -blockers and proton pump inhibitors almost removed the necessity of elective surgical treatment of refractory peptic ulcer disease. Life-threatening complications of peptic ulcer still occur and patients with perforated peptic ulcer almost always need surgical treatment. Material and methods: Seventy-five consecutive patients aged 16-91 years (31 women and 44 men) operated on because of perforated peptic ulcer in our department between 1 January 2001 and 31 December 2009 were studied retrospectively. Results: The mean age was 51.5 ±20.5 years. Of the 75 patients, 34 (45.3%) had co-morbid disease, 14 (18.6%) presented with a delay of more than 24 h, 16 (21.3%) were older than 70 years and 25 (33.3%) were assessed as ASA grade 3 or more. Postoperative complications occurred in 19 patients (25.9%). Cardio-pulmonary failure (5 patients) and wound infection (4 patients) were the most common. The mean hospital stay of recovered patients was 7.7 days (3-38). Eleven (14.6%) patients died. Age above 70 years, presence of comorbid illness, presence of abdominal postoperative complications, American Society of Anesthesiologists (ASA) grade 3 or more, presence of shock on admission and gastric localisation of ulcer were identified as factors increasing risk of mortality. Conclusions: The incidence of perforated peptic ulcer among elderly patients, females in particular, is increasing. The number of patients with perforated peptic ulcer as the first symptom of peptic ulcer is increasing. Perforated peptic ulcer still involves high postoperative mortality.

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Section: Discussioncontrasting

confidence: 52%

Section: Discussionmentioning

confidence: 99%

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Results of surgical treatment of perforated peptic ulcer

Tarnowski¹,

Bielecki²,

Kamiński³

et al. 2011

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“…14 Worldwide literature showed that decrease in mortality of perforation peritonitis which ranges from 25% in 1940 as reported by Bakey D, Jagdish AS et al in their study reported mortality of 8.5%. 29,30 The cause of death was septicaemia, all of which occurred few hours-days postoperatively.…”

Section: Discussionmentioning

confidence: 99%

Clinical study and management of peritonitis secondary to perforated peptic ulcer

2017

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Background: Perforated peptic ulcer is the most common cause among all causes of gastrointestinal tract perforation which is an emergency condition of the abdomen that requires early recognition and timely surgical management. Peptic ulcer perforation is associated significant morbidity and mortality. The aim of study is to evaluate the incidence, clinical presentation, management and outcomes of the patient with peptic ulcer perforation undergoing emergency laparotomy.Methods: This retrospective study includes 45 patients who were operated for perforated peptic ulcer peritonitis at Bundelkhand Medical College and Associated Hospital, Sagar from March 2015 to April 2017. Paediatric patients of age less than 14 years, patients presenting as recurrent perforation were excluded from the study. A detailed history, clinical presentation and routine investigations were done in all cases.Results: In the present study, most of the patients were male. Most of these patients presents with clinical signs of peritonitis between 24-48 hours after onset of the pain. Among the patients of peptic ulcer perforation, duodenal perforation (93.3%) is more common and which is the most common cause of perforation peritonitis. The diagnosis is made clinically and confirmed by presence of gas under diaphragm on radiograph. Exploratory laparotomy with simple closure of perforation with omental patch was done in all cases. The most common post-operative complication was wound infection (57.5%). The overall mortality was 11.1%.Conclusions: Late presentation of peptic ulcer perforation is common with high morbidity and mortality. Surgical intervention with Graham’s omentopexy with broad spectrum antibiotics is still commonly practiced.

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“…[9] Co-existing medical illness, preoperative shock, compromised renal function and delay in treatment are signifi cant risk factors that increase mortality in patients with perforated peptic ulcers. These factors could serve as a guide to opine about the risk to life and to improve the outcome in patients with perforated peptic ulcer.…”

Section: Discussionmentioning

confidence: 99%

Does resuscitation in perforation-operation interval modify the mortality in duodenal perforations?

Prabhu¹,

Prasadi²,

Gore³

2015

Int J Med Public Health

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Objective: An attempt to analyze why in spite of prolonged perforation-operation (PO) interval mortality in patients of perforated duodenal ulcers is less in some patients and whether resuscitative measures in PO interval infl uences mortality particularly in a rural hospital. Materials and Methods: A retrospective analysis of 81 cases of perforated duodenal ulcers presenting in the surgical clinic in a rural medical college which is also a tertiary referral center. Resuscitation, if received in the PO interval was recorded, and a corrected score was calculated and compared statistically with the conventional Boey score. Results were analyzed using Microsoft Excel and SPSS 22 software. Results: Sample size of 81 patients had 70 referred and 11 direct patients. Six out of 11 direct patients succumbed (P = 0.545) and six out of 70 patients succumbed in the referred group (P = 0.086) suggesting that patients presenting directly to the tertiary center with a prolonged PO interval without any intervening resuscitation the prognosis is poor whereas a delayed PO with intervening medical intervention has a better prognosis. The PO interval was 23-168 h with a mean of 42.12 (standard deviation 26.86). Conclusion: In a rural referral center, the resuscitation done in the PO interval is signifi cant as the prognosis is better in the group of patients resuscitated in the PO interval even if there is a delay in the surgical intervention whereas the mortality is higher in those group of patients who have come directly to the center and subjected to surgical procedure, but without any resuscitation in the PO interval. Hence, resuscitation in PO interval is paramount for a better prognosis.

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Perforated Peptic Ulcer in South India: An Institutional Perspective

Abstract: 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.

Cited by 34 publications

References 31 publications

Results of surgical treatment of perforated peptic ulcer

Results of surgical treatment of perforated peptic ulcer

Clinical study and management of peritonitis secondary to perforated peptic ulcer

Does resuscitation in perforation-operation interval modify the mortality in duodenal perforations?

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