Perforated Peptic Ulcer – The Changing Scene

Cocks, John R.

doi:10.1159/000171339

Cited by 30 publications

(21 citation statements)

References 17 publications

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“…In this series, an age >65 years tended to be associated with increased mortality. This finding is in line with other studies in which older patients frequently had associated diseases, or they were more on NSAIDs treatment [8,16,22] . It should be also noted that the mean age of patients from this series was considerably lower than that from patients included in different studies.…”

Section: Discussionsupporting

confidence: 92%

“…Perforation has been found to be a major complication of PUD with a mortality rate ranging from 6 % to 31 % [6][7][8][11][12][13][14][15][16][17][18][19][20] . Age of patients with PPU has been gradually increasing over the last years [21][22][23] . In this series, an age >65 years tended to be associated with increased mortality.…”

Section: Discussionmentioning

confidence: 99%

“…Otherwise, non-definitive surgery was more frequently performed in patients admitted with more risk factors than definitive surgery, and this might explain the higher mortality rate of such studies. Moreover, diffusion of the laparoscopic approach to PPU with less surgical trauma and less metabolic and physiological disturbances, has determined an increase of non definitive surgical procedures performed by simple closures [3,20,22,31] . In the present study, there was no difference in mortality rate between definitive (i.e.…”

Section: Discussionmentioning

confidence: 99%

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Significant factors associated with fatal outcome in emergency open surgery for perforated peptic ulcer

Testini¹,

Portincasa

Piccinni

et al. 2003

WJG

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AIM:To evaluate the main factors associated with mortality in patients undergoing surgery for perforated peptic ulcer referred to an academic department of general surgery in a large southern Italian city. METHODS:One hundred and forty-nine consecutive patients (M:F ratio=110:39, mean age 52 yrs, range 16-95) with peptic ulcer disease were investigated for clinical history (including age, sex, previous history of peptic ulcer, associated diseases, delayed abdominal surgery, ulcer site, operation type, shock on admission, postoperative general complications, and intra-abdominal and/or wound infections), serum analyses and radiological findings. RESULTS:The overall mortality rate was 4.0 %. Among all factors, an age above 65 years, one or more associated diseases, delayed abdominal surgery, shock on admission, postoperative abdominal complications and/or wound infections, were significantly associated (χ 2

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Section: Discussionsupporting

confidence: 92%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Significant factors associated with fatal outcome in emergency open surgery for perforated peptic ulcer

Testini¹,

Portincasa

Piccinni

et al. 2003

WJG

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“…surgical therapy, surgery was shown to improve survival after perforation. 3 However, several other authors [4][5][6][7][8][9] have advocated a more deliberate, nonoperative approach and have shown this approach to be both safe and effective. Thus, the nonoperative management of perforated peptic ulcer remains controversial.…”

Section: Discussionmentioning

confidence: 99%

Sonographic diagnosis and successful nonoperative management of sealed perforated duodenal ulcer

Fujii

Asato

Taniguchi

et al. 2002

J of Clinical Ultrasound

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We encountered a case of sealed perforated duodenal ulcer in a 75-year-old woman with rheumatoid arthritis and chronic renal failure. Abdominal sonography showed a bright linear echo within the thickened anterior wall of the duodenal bulb and the presence of free air at the anterior surface of the liver. We found no signs of direct communication between the duodenal lumen and the peritoneal cavity or any free fluid. On follow-up sonography performed every 2 days during the first week of the patient's hospitalization, no free fluid was found in the abdomen. The use of sonography to diagnose this patient's sealed perforated duodenal ulcer and to monitor the ulcer for the appearance of free fluid allowed us to provide successful nonsurgical management to this patient. We believe that the use of abdominal sonography in all patients suspected of having a perforated duodenal ulcer may help increase the diagnostic accuracy of this modality and may reduce the need for surgery in such patients.

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“…We recently reported a significant decrease in the need of surgery for peptic pyloric stenosis, which is probably due to the influence of treatment with proton pump inhibitors and H. pylori antimicrobe therapy [13]. Another serious complications of GDPU is perforation, which occurs in 2–5% of the patients with ulcer disease, requires emergency surgery and is associated with a morbidity and mortality of around 10% [14, 15]. …”

Section: Introductionmentioning

confidence: 99%

Has the Incidence of Perforated Peptic Ulcer Decreased over the Last Decade? / with Invited Commentary

Sánchez‐Bueno

Marín²,

Ríos³

et al. 2001

Dig Surg

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Background: The therapeutic use of new drugs for inhibiting gastric secretion together with Helicobacter pylori antimicrobe therapy has given rise to controversy over the current incidence of perforated peptic ulcer (gastroduodenal peptic ulcer, GDPU). The aim of this study is to analyze the incidence of ulcer perforation over the last 12 years in our health area and the influence of new medical treatments. Material and Methods: Our series includes 246 patients operated on for perforated peptic ulcer during a 12-year period (January 1987 to December 1998) in our health area. The mean patient age was 55.2 ± 18.1 (16–93) years, and there was a predominance of males (199/246; 80.9%). The ulcer was located fundamentally in the pylorus (48.3%) and duodenal bulb (39.1%), and the most frequent surgical technique was bilateral truncal vagotomy associated with pyloroplasty (85.3%). Results: During the 1987–1992 period, 152 patients underwent surgery, whereas 94 patients were operated on between 1993 and 1998, which reveals a statistically significant difference (p < 0.001). Furthermore, if we divide the study into four 3-year periods (1987–1989, 1990–1992, 1993–1995 and 1996–1998), we see that there were 74 and 78 GDPUs in the first two periods, with no statistical differences between each other, and 48 and 46 cases in the last two periods, also with no statistical differences between each other, but statistically significant when compared to the first two periods. Conclusion: The incidence of perforated GDPU has dropped by half over the last 6 years due fundamentally to the use of proton pump inhibitors.

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Perforated Peptic Ulcer – The Changing Scene

Cited by 30 publications

References 17 publications

Significant factors associated with fatal outcome in emergency open surgery for perforated peptic ulcer

Significant factors associated with fatal outcome in emergency open surgery for perforated peptic ulcer

Sonographic diagnosis and successful nonoperative management of sealed perforated duodenal ulcer

Has the Incidence of Perforated Peptic Ulcer Decreased over the Last Decade? / with Invited Commentary

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