An Anterior Abdominal Abscess as the Initial Presentation of a Perforated Duodenal Ulcer: A Case Report

Yanamaladoddi, Vishnu R; Gonuguntla, Akhilesh; Vasireddy, Anila; Gopal, Nikhil; Janumpalli, Krishna Kalyan Reddy

doi:10.7759/cureus.44522

Cited by 2 publications

(4 citation statements)

References 11 publications

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“…Currently, several surgical techniques are available, with the choice of minimally invasive approaches increasing due to some distinct advantages [7][8][9][10]. In the case of a small perforation in a stable patient, conservative treatment can be an option [5][6][7]10].…”

Section: Introductionmentioning

confidence: 99%

“…A nasogastric tube is inserted, and the GI tract is allowed to heal. If the patient is infected with helicobacter pylori, triple antibiotic therapy with a PPI should be prescribed [4,7,10]. For larger perforations or situations where the patient's condition is deteriorating, surgical intervention is the therapy of choice.…”

Section: Introductionmentioning

confidence: 99%

“…For larger perforations or situations where the patient's condition is deteriorating, surgical intervention is the therapy of choice. The surgical approach could either be laparotomy, laparoscopic, or endoscopic [8][9][10]. Laparotomy and laparoscopy incorporate the same direct closure techniques, that of sutures, clips, omental patches, or, recently, the use of hydrogels [8][9][10][11].…”

Section: Introductionmentioning

confidence: 99%

“…The surgical approach could either be laparotomy, laparoscopic, or endoscopic [8][9][10]. Laparotomy and laparoscopy incorporate the same direct closure techniques, that of sutures, clips, omental patches, or, recently, the use of hydrogels [8][9][10][11].…”

Section: Introductionmentioning

confidence: 99%

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Endoscopic Vacuum-Assisted Closure (E-VAC) in Septic Shock from Perforated Duodenal Ulcers with Abscess Formations

Ciuntu,

Tanevski,

Buescu

et al. 2024

JCM

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This case report underscores the importance of utilizing E-VAC (endoscopic vacuum-assisted closure) in the treatment of a perforated duodenal ulcer complicated by the formation of a subphrenic abscess and septic shock. It showcases how E-VAC can effectively mitigate the risk of further complications, such as leakage, bleeding, or rupture, which are more commonly associated with traditional methods like stents, clips, or sutures. As a result, there is a significant reduction in mortality rates. A perforated duodenal ulcer accompanied by abscess formation represents a critical medical condition that demands prompt surgical intervention. The choice of the method for abscess drainage and perforation closure plays a pivotal role in determining the patient’s chances of survival. Notably, in patients with a high ASA (American Association of Anesthesiologists) score of IV-V, the mortality rate following conventional surgical intervention is considerably elevated. The management of perforated duodenal ulcers has evolved from open abdominal surgical procedures, which were associated with high mortality rates and risk of suture repair leakage, to minimally invasive techniques like laparoscopy and ingestible robots. Previously, complications arising from peptic ulcers, such as perforations, leaks, and fistulas, were primarily addressed through surgical and conservative treatments. However, over the past two decades, the medical community has shifted towards employing endoscopic closure techniques, including stents, clips, and E-VAC. E-VAC, in particular, has shown promising outcomes by promoting rapid and consistent healing. This case report presents the clinical scenario of a patient diagnosed with septic shock due to a perforated duodenal ulcer with abscess formation. Following an exploratory laparotomy that confirmed the presence of a subphrenic abscess, three drainage tubes were utilized to evacuate it. Subsequently, E-VAC therapy was initiated, with the kit being replaced three times during the recovery period. The patient exhibited favorable progress, including weight gain, and was ultimately discharged as fully recovered. In the treatment of patients with duodenal perforated ulcers and associated abscess formation, the successful and comprehensive drainage of the abscess, coupled with the closure of the perforation, emerges as a pivotal factor influencing the patient’s healing process. The positive outcomes observed in these patients underscore the efficacy of employing a negative pressure E-VAC kit, resulting in thorough drainage, rapid patient recovery, and low mortality rates.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Endoscopic Vacuum-Assisted Closure (E-VAC) in Septic Shock from Perforated Duodenal Ulcers with Abscess Formations

Ciuntu,

Tanevski,

Buescu

et al. 2024

JCM

View full text Add to dashboard Cite

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Etiologies and Outcomes Following Duodenal Perforation in Acute Peritonitis: A Systematic Review

Shahi,

Siddiqui,

Khan

et al. 2024

Cureus

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Duodenal perforation often presents as an acute onset of abdominal pain and potential complications such as systemic infection, multiple organ system failure, and even death. It can result from various causes, including peptic ulcer disease (PUD), trauma, malignancies, and infections. Prompt diagnosis and timely intervention are critical for better outcomes, though mortality can be high, particularly in delayed cases. This systematic review aims to synthesize available literature on the etiologies and outcomes associated with duodenal perforation presenting as acute peritonitis, offering a comprehensive overview for guiding effective management strategies. A systematic search was conducted across electronic databases including PubMed, CINAHL, and Google Scholar to identify relevant studies published up to August 2024. Inclusion criteria comprised observational studies, case reports, and case series on duodenal perforation in acute peritonitis. Review articles and non-English language studies were excluded. Two reviewers independently performed data extraction with the opinion of a third reviewer to resolve controversies. Information was gathered on study characteristics, patient demographics, etiology, treatment, and outcomes. A total of 18 studies with 536 participants were included, encompassing a diverse patient population. The primary etiologies identified were PUD, trauma, foreign body, and iatrogenic causes. Treatment approaches ranged from conservative management to surgical interventions, with outcomes varying based on the underlying cause and timeliness of treatment. Postoperative complications were significant, including wound infections, anastomotic leaks, and, in severe cases, multiorgan failure. Mortality was largely associated with delayed intervention. Despite advancements in surgical techniques, the condition still carries a significant risk of complications and mortality, underscoring the need for timely and effective medical care. Future research should focus on developing standardized guidelines to optimize the management of duodenal perforations and reduce associated morbidity and mortality.

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An Anterior Abdominal Abscess as the Initial Presentation of a Perforated Duodenal Ulcer: A Case Report

Cited by 2 publications

References 11 publications

Endoscopic Vacuum-Assisted Closure (E-VAC) in Septic Shock from Perforated Duodenal Ulcers with Abscess Formations

Endoscopic Vacuum-Assisted Closure (E-VAC) in Septic Shock from Perforated Duodenal Ulcers with Abscess Formations

Etiologies and Outcomes Following Duodenal Perforation in Acute Peritonitis: A Systematic Review

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