Study of the effect of post-operative medical management on peptic ulcer in patients of perforated peptic ulcer disease

Abstract

INTRODUCTIONPeptic ulcer disease (PUD) remains one of the most prevalent diseases of the gastrointestinal tract with annual incidence 1 ranging from 0.1% to 0.3% in India. Cases of peptic ulcer perforation are commonly encountered in our institute. The high incidence of mortality and morbidity associated with this condition, promoted us to carry out an in depth study of this condition. There are well known two major precipitating factors: Helicobacter pylori infection and the use of non-steroidal anti-inflammatory drugs (NSAIDs) and the ulcer incidence increase with age for both duodenal and gastric ulcers. ABSTRACTBackground: Peptic ulcer disease remains one of the most prevalent diseases of the gastrointestinal tract with annual incidence 1 ranging from 0.1% to 0.3% in India. Cases of peptic ulcer perforation are commonly encountered in our institute. The objective was to study the effect of post-operative medical management on peptic ulcer in patients of perforated peptic ulcer disease. Methods: A prospective non randomized study was conducted among all diagnosed cases of peptic ulcer perforation patients admitted through emergency or OPD in surgery ward in our hospital. Patient's case record was evaluated to collect following data: personal information, past history of peptic ulcer disease, use of non-steroidal antiinflammatory drugs for heart disease or osteoarthritis was taken. Tests such as detail clinical history, patient's prescription, rapid urease test, upper GI endoscopy were done. Results: Most common age group affected is, 50 years and above. Duodenal perforations were more common in age group of 50 years and above. Most of these patients present with clinical signs of peritonitis 24 hours after onset of pain. 84% of total patients were male patients and 16% were female patients. Among the patient of peptic ulcer perforation, duodenal perforation is more common, and which is most common cause of perforation peritonitis. Guarding and rigidity was present in 84% of patients. Diagnosis is made clinically and confirmed by presence of pneumoperitoneum on radiograph. Exploratory laparotomy with simple closure of perforation with omental patch after that peritoneal lavage with normal saline is commonest operative management perforated peptic ulcer. Most common post-operative complication observed was wound infection and lower respiratory tract infection. The overall mortality was 4%. Conclusions: Perforation peritonitis is common in elderly population. Pain in abdomen and distension of abdomen are most common presenting feature. Early diagnosis by clinical assessment and presence of pneumoperitoneum is important followed by resuscitation and laparotomy with simple closure of perforation.

Focus on the Perforated Peptic Ulcer

“…Endoscopic treatment for small gastric defects (<10mm) using TTS (through-the-scope clips) with a linear shape, is an acceptable method and should be attempted. Endoscopic treatment for large gastric defects (>10mm) by the OTSC (over-the-scope clip system) can be efficient in duodenal perforation [44].…”