Perforated Peptic Ulcer: Main Factors of Morbidity and Mortality

Noguiera, Carlos; Silva, Ant�nio S�rgio; Santos, José; Silva, Ant�nio Gomes; Ferreira, Joaquim J.; Matos, Eduarda; Vila�a, Hernani

doi:10.1007/s00268-003-6645-0

Cited by 118 publications

(120 citation statements)

References 14 publications

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“…For ulcer perforation, standard treatment is immediate intervention with either simple closure or a more complex surgical procedure (8,9). Delayed treatment is probably a major prognostic fac- Unstratified estimates and values stratified for the presence of heart and renal disease.…”

Section: Peptic Ulcer Perforationmentioning

confidence: 99%

“…Peptic ulcer bleeding and perforation are common medical emergencies, with an in-hospital or 30-day mortality of ϳ10% for bleeding ulcers (7,8) and up to 25-40% for ulcer perforation (9). Patients with diabetes may have poorer outcomes after peptic ulcer complications due to diabetic angiopathy (6), delayed ulcer healing (10), blurring of symptoms due to autonomic neuropathy, and increased risk of bacterial sepsis (11).…”

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confidence: 99%

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Diabetes and 30-Day Mortality From Peptic Ulcer Bleeding and Perforation

et al. 2006

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OBJECTIVE— Diabetes may influence the outcome of complicated peptic ulcer disease, due to angiopathy, blurring of symptoms, and increased risk of sepsis. We examined whether diabetes increased 30-day mortality among Danish patients hospitalized with bleeding or perforated peptic ulcers. RESEARCH DESIGN AND METHODS— This population-based cohort study took place in the three Danish counties of North Jutland, Viborg, and Aarhus between 1991 and 2003. Patients hospitalized with a first-time diagnosis of peptic ulcer bleeding or perforation were identified using the counties’ hospital discharge registries. Data on diabetes, other comorbidities, and use of ulcer-associated drugs were obtained from discharge registries and prescription databases. The Danish Civil Registry System allowed complete follow-up for mortality. The outcome under study was 30-day mortality in diabetic versus nondiabetic patients, adjusted for potential confounders. RESULTS— We identified 7,232 patients hospitalized for bleeding ulcers, of whom 731 (10.1%) had diabetes. The 30-day mortality among diabetic patients was 16.6 vs. 10.1% for other patients with bleeding ulcers. The adjusted 30-day mortality rate ratio (MRR) for diabetic patients was 1.40 (95% CI 1.15–1.70). We also identified 2,061 patients with perforated ulcers, of whom 140 (6.8%) had diabetes. The 30-day mortality among diabetic patients was 42.9 vs. 24.0% in other patients with perforated ulcers, corresponding to an adjusted 30-day MRR of 1.51 (1.15–1.98). CONCLUSIONS— Among patients with peptic ulcer bleeding and perforation, diabetes appears to be associated with substantially increased short-term mortality.

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Section: Peptic Ulcer Perforationmentioning

confidence: 99%

mentioning

confidence: 99%

Diabetes and 30-Day Mortality From Peptic Ulcer Bleeding and Perforation

et al. 2006

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“…On the other hand, numerous studies have shown that the presence of accompanying diseases has a significant effect on postoperative mortality and morbidity. In these studies, pulmonary diseases, hypertension (HT), diabetes mellitus (DM), and cardiac diseases were found to be of importance with varying frequency (5,27,28). In our study, the presence of DM, HT, renal failure, heart failure, COPD, and malignancies was observed to be related with a significantly increased risk of postoperative mortality and morbidity.…”

Section: Discussionmentioning

confidence: 55%

Is it possible to reduce the surgical mortality and morbidity of peptic ulcer perforations?

Hut

Tatar²,

Dogan

et al. 2017

Turk J Surg

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INTRODUCTIONWith regard to creating a novel vision for former diseases, our memorizationsshould be updated. Some diseases and their outcomes, which have been previously very well known, are nowadays almost always presented as unexpected cases because of new technologies and evolvements in medicine due to resistant events. Thus, antiulcer medication and presentation of elderly patients have changed in peptic ulcer perforation (PUP) and, transforming the patient profiles with PUP in our era. Therefore, a novel vision to avoid gaps is necessary to evaluate the patients with PUPsas surgeons are coming across newer patient profiles in last decades. Peptic ulcers are focal defects in the stomach and the duodenum extending below the mucosa or deeper (1, 2). They can be acute or chronic; the etiology of the condition is the disruption of balance between gastric acid effect and mucosal defense mechanisms (2, 3). Although medical treatments such as H2 receptor antagonists, proton pump inhibitors, and Helicobacter pylori eradication through antibacterial drugs, have decreased the number of surgeries in non-complicated peptic ulcer cases, the number of patients presenting to the emergency clinics with peptic ulcer perforation has not decreased (1-5).Peptic ulcer perforation is still an important health problem, despite the decreasing incidence of peptic ulcer disease. The aim of this study was to investigate factors affecting the mortality and morbidity of PUPs and specifically determine approaches to decrease mortality. MATERIAL AND METHODSThe data from 112 patients operated with the diagnosis of PUP at our Training and Research Hospital between January 2010 and December 2015 were retrospectively analyzed. Patient age, gender, weight, height, American Society of Anesthesiologists (ASA) score, symptoms, time interval between symptom onset and surgery, accompanying diseases, length of hospital stay, operative technique, laboratory findings, site and diameter of perforation, Acute Physiology and Chronic Health Evaluation (APACHE) II and Mannheim Peritonitis Index (MPI) scores, preoperative shock state, morbidity, and mortality were recorded. MPI (Table 1) and APACHE II scores were calculated for all patients. Patient age, chronic health status, rectal temperature, mean arterial blood pressure, heart rate, respiratory rate, arterial pH, partial oxygen pressure, serum sodium, serum potassium, serum creatinine, hematocrit, white blood cell count, and Glasgow coma score were recorded for determining the APACHE II score. 267Objective: Peptic ulcer perforation is a life-threatening situation requiring urgent surgical treatment. A novel vision in peptic ulcer perforation is necessary to fill the gaps created by antiulcer medication, aging of the patients, and presentation of resistant cases in our era. In this study, we aimed to share our findings regarding the effects of various risk factors and operative techniques on the mortality and morbidity of patients with peptic ulcer perforation. Material and Methods:Data from 112 patient...

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“…[1] Peptic ulcer disease is the most common cause of duodenal perforation. [1,2] Peptic ulcer disease is a frequent pathology that is caused by different disorders. Helicobacter pylori infection, nonsteroidal anti-inflammatory drugs, liver cirrhosis, hyperparathyroidism, and chronic pancreatitis are related to peptic ulcer disease.…”

Section: Resultsmentioning

confidence: 99%

“…[2,7,23] The technical difficulties of suturing in laparoscopic and endoscopic approaches have led to research studies about sutureless repair for duodenal perforations. [7,23,24] Application of effective sutureless repairing techniques for intestinal perforations is being studied with new chemical agents to create a proper minimally invasive technique.…”

Section: Discussionmentioning

confidence: 99%

Comparison of classical surgery and sutureless repair with DuraSeal or fibrin glue for duodenal perforation in rats

Avcı

Yüceyar

Aytaç³

et al. 2011

Ulus Travma Acil Cerrahi Derg

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AMAÇBu çalışmada, sıçanlarda oluşturulan deneysel duodenum perforasyonunda klasik cerrahi teknikler ile adezyon bariyerleri olan DuraSeal ya da fibrin yapıştırıcıyla yapılan dikişsiz onarım tekniklerinin karşılaştırılması amaçlandı. GEREÇ VE YÖNTEMKırk adet yetişkin, ağırlıkları 250-300 g arasında olan, dişi Wistar Albino sıçan rastgele dört adet eşit gruba ayrıldı. Primer onarım grubu, primer onarım ve omentoplasti grubu, fibrin yapıştırıcı uygulanan grup ve DuraSeal uygulanan grup. Doku iyileşmesini değerlendirmek amacıyla patlama basıncı, doku hidroksiprolin seviyesi ve histopatolojik inceleme parametre olarak kullanıldı. BULGULARPrimer onarım, primer onarım ve omentoplasti gruplarının patlama basıncı değerleri fibrin yapıştırıcı ve DuraSeal grubu patlama basıncı değerlerine göre anlamlı olarak yüksek-ti (p<0,001). Biyokimyasal ve histolojik parametreler açı-sından tüm gruplar arasında anlamlı farklılık yoktu. SONUÇDeğerlendirdiğimiz dikişsiz onarım tekniklerinin konvansiyonel onarım tekniklerine üstün etkilerinin olmadığını gözlemledik. Dikişsiz onarım gruplarının sonuçları benzerdi. DuraSeal, fibrin yapıştırıcı gibi dikişsiz onarım alanın-da alternatif olabilir. Bu çıkarım farklı yara iyileşmesi belirteçleri ve farklı yöntemlerle planlanmış çalışmalarla desteklenmelidir.Anahtar Sözcükler: DuraSeal; duodenal perforasyon; fibrin yapış-tırıcı; dikişsiz tamir.

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Perforated Peptic Ulcer: Main Factors of Morbidity and Mortality

Cited by 118 publications

References 14 publications

Diabetes and 30-Day Mortality From Peptic Ulcer Bleeding and Perforation

Diabetes and 30-Day Mortality From Peptic Ulcer Bleeding and Perforation

Is it possible to reduce the surgical mortality and morbidity of peptic ulcer perforations?

Comparison of classical surgery and sutureless repair with DuraSeal or fibrin glue for duodenal perforation in rats

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