Clinical study and management of peritonitis secondary to perforated peptic ulcer

Abstract

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.

Implications of Bacteriological Study in Perforated Peptic Ulcer Peritonitis

“…The postoperative outcome after surgical repair is in uenced by delayed presentation, presence of pus in the peritoneal cavity, sepsis and shock. 13 The choice of the surgical approach (laparoscopy versus laparotomy) has an impact on the immune response in PPU. Schietroma et al, in a study on 119 patients with PPU, showed that 1 hour after the intervention, bacteraemia and the levels of endotoxin was signi cantly higher for the patients who undergo surgery by laparotomy.…”

Implications of Bacteriological Study in Perforated Peptic Ulcer Peritonitis

“…Surgical intervention is the most widespread attitude practiced in cases of PPU. The postoperative outcome after surgical repair is influenced by delayed presentation, presence of pus in the peritoneal cavity, sepsis and shock (13). The choice of the surgical (laparoscopy versus laparotomy) has an impact on the immune response in PPU.…”

Focus on the Perforated Peptic Ulcer

“…Use of steroids and older age are well known risk factors for mortality in perforated gastroduodenal ulcer whereas they were associated with a reduced risk of re-intervention. There is a protective effect of older age and steroid use and it might be related to the fact that elderly patients and those treated with steroids may display atypical clinical symptoms, which challenges the diagnosis of surgical complications [22]. Due to the high fetal mortality during the pregnancy in case of peritonitis due to an ulcer perforation, prophylactic steroid administration during the pregnancy as for significant leucopenia should be limited [23].…”