Perforated peptic ulcer (PPU): a one year review in tertiary care hospital in Uttarakhand, India

Authors

  • Praveen Kumar Department of General Surgery, SGRRIMHS and SMIH, Dehradun, Uttarakhand, India
  • Nilkamal Kumar Department of General Surgery, SGRRIMHS and SMIH, Dehradun, Uttarakhand, India

DOI:

https://doi.org/10.18203/2349-2902.isj20175533

Keywords:

Omental patch, Perforation, Peptic ulcer

Abstract

Background: Peptic ulcer perforation is a common surgical emergency. The perforation usually involves the anterior wall of duodenum (60%), although, it might occur in antrum (20%) and lesser curvature of stomach (20%). Conventional open surgery involving repair with omental patch remains the gold standard treatment. This study evaluates the patterns and demographic factors associated with this common surgical disease and the outcome analysis of surgery in our state.

Methods: The study was undertaken for patients admitted in surgery department in a single unit who underwent open surgery for perforated peptic ulcer. A total of 78 patients were assessed between January 2016 to January 2017.

Results: The study found PPU to be a male dominated disease in fifth decade and with significant association with smoking and alcohol consumption. First part of duodenum being the commonest location of PPU, the peritoneal contamination was directly associated with the duration of symptoms. Wound infection was the most frequent post-operative complication. Simple repair with omental patch remains an effective treatment modality.

Conclusions: Perforated peptic ulcer disease commonly affects middle aged males especially due to association with alcohol intake. Simple closure with omental patch followed by H. pylori eradication is an effective treatment modality.

References

Moller MH, Adamsen S, Thomsen RW, Møller AM. Multicentre trial of a perioperative protocol to reduce mortality in patients with peptic ulcer perforation. Br J Surg. 2011;98(6):802-10.

Malfertheiner P, Chan FK, McColl KE. Peptic ulcer disease. Lancet. 2009;374(9699):1449-61.

Lau JY, Barkun A, Fan DM, Kuipers EJ, Yang YS, Chan FK. Challenges in the management of acute peptic ulcer bleeding. The Lancet. 2013;381(9882):2033-43.

Wang YR, Richter JE, Dempsey DT. Trends and outcomes of hospitalizations for peptic ulcer disease in the United States, 1992 to 2006. Ann Surg. 2010;251(1):51-8.

Lau JY, Sung J, Hill C, Henderson C, Howden CW, Metz DC. Systematic review of the epidemiology of complicated peptic ulcer disease: incidence, recurrence, risk factors and mortality. Digest. 2011;84(2):102-13.

Güzel H, Kahramanca S, Şeker D, Özgehan G, Tunc G, Küçükpınar T, et al. Peptic ulcer complications requiring surgery: what has changed in the last 50 years in Turkey. Turkish J Gastroenterol. 2014;25(2):152-5.

Buck DL, Vester-Andersen M, Moller MH. Surgical delay is a critical determinant of survival in perforated peptic ulcer. Br J Surg. 2013;100(8):1045-9.

Nuhu A, Madziga AG, Gali BM. Acute perforated duodenal ulcer in Maiduguri. Internet J Surg. 2009;21:1.

Turkdogan MK, Hekim H, Tuncer I, Aksoy H. The epidemiological and endoscopic aspects of peptic ulcer disease in Van region. Eastern J Med 1999;4(1):6-9.

Henry D, Dobson A, Turner C. Variability in the risk of major gastrointestinal complications from non-steroidal anti-inflammatory drugs. Gastroenterol. 1993;105:1078.

Gisbert JP, Pajares JM. Helicobacter pylori infection and perforated peptic ulcer prevalence of the infection and role of antimicrobial treatment. Helicobacter. 2003;8:159-67.

Ng EK, Lam YH, Sung JJ, Yung MY, Chung SC, Lee DW et al. Eradicatuion of Helicobacter pylori [prevents recurrence of ulcer after simple closure of duodenal ulcer perforation: randomized controlled trial. Ann Surg. 2000;231:153.

Mathur PN, Kumawat JL, Joshi CP, Parihar S. Retrospective study of perforated peptic ulcer: a surgical emergency. Int Surg J. 2017;4(1):19-23.

Lee FY, Leung KL, Lai BS, Ng SS, Dexter S, Lau WY. Predicting mortality and morbidity of patients operated on for perforated peptic ulcers. Arch Surg. 2001;136:90-4.

Mansberger JA. Endoscopic follow-up of the perforated duodenal ulcer. Am Surg. 1987;53(1):46-9.

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Published

2017-12-26

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Original Research Articles