Perforated Peptic Ulcers: 3 Year Experience in Klaipeda University Hospital

Abstract

Perforation is second most common complication of peptic ulcers with mortality rate ranging from 3 to 30 %. For best outcomes this condition must be diagnosed and managed as soon as possible. Objectives and methods. The aim of this study was to present our clinical experience in managing perforated peptic ulcers. Retrospective data analysis of patients treated for perforated peptic ulcers from year 2015 to 2017 was performed. Statistical data analysis was carried out using the SPSS 20.0 software. Results. 90 patients were treated for perforated peptic ulcers. The female and male ratio was 1:1.25 with the mean patient age of 61.60±19.42 years. There were no more data from 16 patients. The average hospital stay was 12.89±13.31 days. 11% of the patients had type I, 49% – type II, 24% – type III, 5%- type IV, 11% – type V ulcer according to modified Johnson classification. 91% underwent ulcerorrhaphy, 4% -Billroth type I surgery, 2% – Billroth type II surgery and 1% had atypic resection. 84% of surgeries were performed with laparotomic approach, 12% – laparos-copically, 4% had a conversion. The mean duration of the operation was 85.2±4.64 minutes. The average Mannheim Peritonitis Index between the patients was 17.135±7.36. 24% of patients with perforated peptic ulcer died. Statistically significant correlation was observed between the Mannheim Peritonitis Index and mortality (r=0.640; p<0.05), age and mortality (r=0.459; p<0.05) and between age and Mannheim Peritonitis Index (r=0.740; p<0.05). Conclusion. During the period from 2015 to 2017 90 patients were treated for PPU. Half of the patients had type II ulcer localization according to modified Johnson classification. Simple closure was performed for 91% of the patients, 84% of all surgeries were performed with an open approach. Statistically significant correlation was found between Mannheim Peritonitis Index and mortality, age and mortality and between age and Mannheim Peritonitis Index. No significant correlation was observed between the approach and the outcome. There could be a bigger role in laparascopic surgery treating PPU. It is important for clinicists to consider about PPI for treatment when prescribing NSAIDs, especially in elderly and hospitalized patients in order to avoid peptic ulcers and its complications.