Perforated Gastric Ulcer

Abstract

Background/Aims: Reports about perforated gastric ulcer are scarce and thus it is difficult to settle for a uniform model of operative management. The purpose of the study was to review our experience with perforated gastric ulcer and evaluate the results of gastric resection vs. oversewing of the perforation. Methods: Within 36 years 77 patients with peritonitis caused by histologically confirmed perforated gastric ulcer were operated. Furthermore, in another 7 microscopic examination revealed that perforation occurred within the gastric cancer. There were twice as many male as female patients. Results: Recently, the overall postoperative mortality (20.8%) tended to decrease markedly. 32 patients (mean age 49.9 years) were submitted to gastric resection and this procedure was associated with 2.9% mortality. All 3 subjects in whom vagotomy, pyloroplasty and wedge resection of the ulcer had been performed survived. In 40 patients (mean age 61.5 years) only a suture of the ulcer was performed. This procedure was associated with high mortality (1/3 of patients died). Selection criteria included poor general medical status, age, comorbidities, and substantial progression of the inflammatory process. Conclusion: Authors believe that emergency gastrectomy is a safe procedure; however, it might be performed without excessive operative risk in only half of the patients.

Tuberculous Gastric Perforation: Report of a Case

“…Resection of the distal part of the stomach, including the ulcer, is considered better for a perforated gastric ulcer than suturing alone. 15 A full course of ATT should always complement any operation for GT.…”

Morbidity and mortality of perforated peptic gastroduodenal ulcer following emergency surgery

“…There is an ongoing debate over whether simple closure (with or without omentoplasty) is safe and sufficient to treat perforated ulcer, or whether resectional surgery ("definitive surgery") which has been commonly performed in recent decades and is still commonly used in Japan, Asian countries, and Eastern Europe, should be the preferred surgical option [2,20,21,22]. In Japan high rates of gastric resection are reported (up to 80%), while simple closure or fibrin glue is performed in less than 5% of cases [10,20].…”

Results of surgical treatment of perforated peptic ulcer

“…Suturing of a gastric ulcer was carried out in patients 10 years older on average and in worse general condition with the APACHE II score statistically significantly higher than among other patients treated by resection. The outcomes were worse -15 out of 40 patients (37.5%) died [41]. A similar tactic was adopted by Chandra et al when qualifying low-risk patients for stomach resection and restricting the surgery to suturing of the perforation in higher-risk patients.…”