Management of Giant Gastric Ulcer Perforation: Report of a Case and Review of the Literature

Vashistha, Nitin; Singhal, Dinesh; Makkar, Gurpreet; Chakravarty, Suneel; Raj, Vivek

doi:10.1155/2016/4681989

Cited by 4 publications

(7 citation statements)

References 10 publications

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“…The choice of approach in the management of gastric perforation, regardless of its size, depends on the infrastructure of the Center and the operator. Indeed, laparoscopy is now increasingly used, even before a giant gastric ulcers [18]. Many authors reported its safety and efficiency in this case [21][22][23].…”

Section: Discussionmentioning

confidence: 81%

“…In our series, the discovery of pneumoperitoneum on radiological images which led us to suspect an hollow organ perforation, was sufficient to decide for an urgent surgery. Furthermore, abdominal ultrasound and Computed Tomography with contrast injection can also help to guide diagnosis by the presence of intra-abdominal fluid effusion but have the disadvantage of being more expensive and depend on the operator In the case of a large gastric ulcer perforation, CT has its advantage because, in addition to the presence of pneumoperitoneum, it could specify the site of perforation by the concentration of extraluminal air bubbles in immediate proximity or by revealing a thickening of the focal wall of the stomach and its discontinuity [18]. Extravasation of the oral contrast on CT gives the diagnosis of perforation with a low sensitivity, between 19% and 42% with the risk of delaying the surgical procedure [19].…”

Section: Discussionmentioning

confidence: 99%

“…An early and appropriate management is essential to avoid additional complications, including unnecessary gastrectomy [20]. Associated complications may include hemorrhage with its effects, progressive alteration of the patient's general state due to SIRS, or even sepsis [15,18].…”

Section: Discussionmentioning

confidence: 99%

“…Other authors prescribe an additional omental sealing. There are other surgical options such as the free jejunal pedicle flap, partition wall construction and Finney's pyloroplasty, rarely used [18]. Nivatongs recommends for the patients using NSAIDs and for the Helicobacter pylori infection, the combination of acid-reducing gastric surgery such as a truncular or a selective vagotomy [12].…”

Section: Discussionmentioning

confidence: 99%

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Clinical and Therapeutic Aspects of Perforated Peptic Ulcer in Joseph Ravoahangy Andrianavalona University Hospital Center

Rakotomena¹,

Arimino²,

Lovasoa³

et al. 2019

SJCM

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Despite the introduction of H2 receptor and proton pump antagonists into the therapeutic arsenal of the Peptic Ulcer Disease, gastric perforation remains the most common surgical emergery for the upper gastrointestinal tract. The present study aims to describe the particularities of the management of Perforated Peptic Ulcer which underwent surgery in the University Hospital Center Joseph Ravoahangy Andrianavalona Antananarivo (CHU-JRA) and to identify its morbidity and mortality factors. This is a retrospective analysis performed over a period of 33 months from January 2017 to September 2019 on Perforated Peptic Ulcer operated in CHU-JRA. Demographic, clinical and therapeutic parameters were studied and analyzed in relation to the morbidity and mortality rate. Altogether 158 patients operated for perforated Gastric or Duodenal Ulcer were included with an age ranging from 16 to 78 years old, a mean age of 39.05±15.03 years and a Sex Ratio estimated to 18.75. Repeated unexplored epigastralgia was noted in 70.89% of cases and 33.54% of patients used NSAIDs and/or corticosteroids before the onset of the pain. At admission, 9.4% of cases were immediately in shock. A laparotomy for exploration and repair was performed for a suspicion of a hollow-organ perforation on a X-ray of an Unprepared Abdomen. Antral perforation predominated in our serie (75.95%) and the main repair procedure consisted in a simple surgical suture. To conclude, our stude reflects the difficulty of the management of Peptic Ulcer Disease and its complications in our daily practice. Strenghtening the awareness of the population about the potiential severity of this disease is essential.

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Section: Discussionmentioning

confidence: 81%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Clinical and Therapeutic Aspects of Perforated Peptic Ulcer in Joseph Ravoahangy Andrianavalona University Hospital Center

Rakotomena¹,

Arimino²,

Lovasoa³

et al. 2019

SJCM

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show abstract

“…Prognosis in elderly patients are particularly poor because of advanced age and comorbidities [14,15]. Furthermore, there is no specific recommendation for their management despite a variety of repair techniques being described [12,16]. Here, we aim to describe a novel technique used to treat such patients, especially those of advanced age, in our institution and to review the current literature.…”

Section: Introductionmentioning

confidence: 99%

Duodenojejunostomy, an Old Technique but Novel Solution for Giant Duodenal Perforations - A Report of Four Cases and Review of Literature

Lee¹,

Shulin²,

Li³

et al. 2020

SCR

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Background: Despite advances in the medical management of peptic ulcer disease, duodenal ulcer (DU) perforation remains a common surgical emergency. Most DU perforations are small and can be managed with omental patch repair. However, occasionally the surgeon may encounter a giant perforation not amenable to this. Giant DU perforations are defined as > 2cm. They are associated with high leak rates and mortality. Prognosis in elderly patients are particularly poor because of advanced age and comorbidities. Furthermore, there are no specific recommendations for their management despite a variety of repair techniques being described. Here, we aim to describe a novel technique used to treat such patients, especially those of advanced age, in our institution and to review the current literature. Case presentation: Four patients with giant DU perforation underwent emergency laparotomy and repair with our duodenojejunostomy technique at our hospital. Post-operatively, patients were monitored clinically and radiologically and discharged when well and tolerating diet. The mean age of the patients was 67 years with an equal gender distribution. The average Charlson Comorbidity Index (CCI) score was 3 (moderately severe). All presented with peritonitis and two had concomitant bleeding. There were two anterior and two posterior ulcers. One was a revision repair after a leak post laparoscopic omental patch repair for the initial perforation. In all cases, the duodenojejunostomy repair technique was used. Post-operative recovery was uneventful for all except one who developed pneumonia. In particular; there were no anastomotic leaks, intra-abdominal collections, gastric outlet obstructions or mortalities. Conclusion: Giant DU perforation remains a challenge to the general surgeon, particularly so in elderly patients with multiple comorbids. A review of the current literature suggests a myriad of surgical techniques but no perfect solution. Some suggested techniques include omental patch with pyloric exclusion, controlled tube duodenostomy, jejunal pedicled graft or serosal patch, gastric disconnection and partial gastrectomy. Here, we propose that isolated duodenojejunostomy can be a quick, safe and novel solution that ensures definitive repair of giant ulcer perforation in a single setting in the high-risk patient.

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Omental plug using double horizontal mattress suture for gastric perforation on elderly patients with boey score 3: A case series

Handaya

Andrew

Hanif

et al. 2021

Annals of Medicine &Amp; Surgery

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Introduction Gastric perforation is a life-threatening condition. Patients with gastric perforation with Boey score 3 has very high mortality rate. Immediate source control is required for primary repair and preventing further complications. Furthermore, elderly patients pose a greater risk of morbidity and mortality in cases of gastric perforation, especially during and after emergency surgery. Case presentation We present two cases of elderly patients with gastric perforation with Boey score 3. We performed omental plugging technique with double horizontal mattress suture type. In these cases, we decided not to perform biopsy and margin freshening of the perforation. Discussion We performed omental plugging technique because we are confident that it could cover the perforation completely without causing gastric outlet obstruction. An emergency source control surgery can be effectively done with this omental plugging procedure. During surgery, margin freshening and biopsy is not performed to perform source control more quickly. This surgical procedure aligned with “quick in-quick out” concept that we adopted for treating patients with gastric perforation. Omental plugging also allows patient to undergo ERAS program for better and faster recovery. The patients were discharged from the hospital without further complications and long-term follow-up showed good results. Conclusion Omental plugging has the least risk of complications than other perforation repair techniques and can be done for small and large perforation. Based on our case series, omental plug with double mattress suture is an effective and safe procedure to be performed in elderly patients with gastric perforation with Boey score 3.

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Management of Giant Gastric Ulcer Perforation: Report of a Case and Review of the Literature

Cited by 4 publications

References 10 publications

Clinical and Therapeutic Aspects of Perforated Peptic Ulcer in Joseph Ravoahangy Andrianavalona University Hospital Center

Clinical and Therapeutic Aspects of Perforated Peptic Ulcer in Joseph Ravoahangy Andrianavalona University Hospital Center

Duodenojejunostomy, an Old Technique but Novel Solution for Giant Duodenal Perforations - A Report of Four Cases and Review of Literature

Omental plug using double horizontal mattress suture for gastric perforation on elderly patients with boey score 3: A case series

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