×
Home
Current Archive Submission Guidelines
News Contact
Research paper

Treatment of Perforative Peptic Ulcer

By
Ivana Đorđević ,
Aleksandar Zlatić ,
Aleksandar Zlatić
Irena Janković
Irena Janković

Abstract

Perforation of peptic ulcer (PPU) is the most frequent complication of peptic ulcer disease. PPU is a serious complication which demands urgent diagnostic procedures, reanimation and surgical intervention.  
The aim of this study was to establish the frequency of PPU, diagnostic and therapy procedures, time and kind of surgical methods, as well as morbidity and mortality in two groups of patients. Based on the results obtained, it will be concluded if there is a statistically significant improvement in treating these patients. 
The paper presents a prospective-retrospective study which included patients treated at the Surgical Clinic, Clinical Center Niš, in the period 1994-2006.  The patients were divided into two groups: A - examined group (2001-2006) and B - control group (1994-2000). The division was done based on the application of better and quicker diagnostic and reanimation procedures, urgent surgical treatment of secondary bacterial peritonitis (SBP) in A group patients, while such possibilities lacked in B group patients.    
The results of this study showed that 168 patients from the A group and 197 patients from the B group underwent the same surgical procedures, but with a significant decrease in number and severity of postoperative complications: (53.57% of patients and 91.87% of patients, respectively) (p<00001). Mortality of patients in groups A and B was 17.8% and 27.4%, respectively (p=0,042). 
The results on mortality obtained in the A group patients are in keeping with the literature data, which, on the other side, is not the case when discussing the ways of treating PPU, the incidence and numerous complications. This high risk group of patients demands worldly acknowledged surgical and reanimation procedures. 

References

1.
Jeremić M, Pešić M. Hirurgija želuca i duodenuma. Specijalna hirurgija I-dijagnostika i terapija. Medicinski fakultet Niš. 2001;(7):8–16.
2.
Jeremić M, Pešić M. Hirurgija želuca i duodenuma. Specijalna hirurgija I-dijagnostika i terapija. Medicinski fakultet Niš. 2001;(7):16–8.
3.
Wysocki A, Budzyński P, Kulawik J, Drożdż W. Changes in the localization of perforated peptic ulcer and its relation to gender and age of the patients throughout the last 45 years. World Journal of Surgery. 2011;(4):811–6.
4.
Hussain N, Karnath B. Perforated Peptic Ulcer. Emerg Med. 2003;(7):17–9.
5.
Møller M, Adamsen S, Thomsen R, Møller A. British Multicentre trial of a perioperative protocol to reduce mortality in patients with peptic ulcer perforation. British Journal of Surgery. 2011;(6):802–10.
6.
Kirschner M. Die Behandlund der akuten eitrigen freien Bauchfellentzundung. Langenb Arch Chir. 1926;253–67.
7.
Mcquaid K, Tierney L, Mcphee S, Papadakis M. Diseases of the peritoneum. Current Medical Diagnosis and Treatment. 1999;558–63.
8.
Laroche M, Harding G. Primary and secondary peritonitis: an update. Eur J Clin Microbiol Infect Dis. 1998;(8):542–50.
9.
Van Goor H, De Graaf J, Grond J. Fibrinolytic activity in the abdominal cavity of rats with faecal peritonitis. Br J Surg. 1994;(7):1046–9.
10.
Rotstein O. Role of fibrin deposition in the pathogenesis of intraabdominal infection. Eur J Clin Microbiol Infect Dis. 1992;(11):1064–8.
11.
Konig C, Simmen H, Blaser J. Bacterial concentrations in pus and infected peritoneal fluid-implications for bactericidal activity of antibiotics. J Antimicrob Chemother. 1998;(2):227–32.
12.
Brugger L, Seiler C, Mittler M. New approaches to the surgical treatment of diffuse peritonitis. Zentralbl Chir. 1999;(3):181–6.
13.
Schein M, Saadia R, Decker G. Intraoperative peritoneal lavage. Surg Gynecol Obstet. 1988;(2):187–95.
14.
Genuit T, Napolitano L, Jacocks A, Talavera F, Morris D, Zamboni P. John Geibel J Peritonitis and Abdominal Sepsis. 2002;158–64.
15.
Segawa M, Kusajima Y. Pyopneumopericardium caused by perforation of gastric ulcer; report of a case. Kyobu Geka. 2005;(5):415–8.
16.
Pasnik K, Krupa J, Stanowski E, Grzesiak J, Najdecki M. Successful treatment of gastric fistula following rhabdomyolysis after vertical banded gastroplasty. Obes Surg. 2005;(3):428–30.
17.
Songne B, Jean F, Foulatier O, Khalil H, Scotte M. Non operative treatment for perforated peptic ulcer: results of a prospective study. Ann Chir. 2004;(10):578–82.
18.
Schein M, Gecelter G, Freinkel Z, Gerding H. APACHE II in emergency operations for perforated ulcers. Am J Surg. 1990;(3):309–13.
19.
Mishra A, Sharma D, Vk R. A simplified prognostic scoring system for peptic ulcer perforation in developing countries. Indian J Gastroenterol. 2003;(2):49–53.
20.
Viera A, Cubano M. Perforated Gastric Ulcer In An Eleven Year Old. Jacksonville Medicine. 1998;303–8.
21.
Forsmo H, Glomsaker T, Vandvik P. Perforated peptic ulcer-a 12-year material. Tidsskr Nor Laegeforen. 2005;(13):1822–4.
22.
Vettoretto N, Poiatti R, Fisogni D, Diana D, Balestra L, Giovanetti M. Comparison between laparoscopic and open repair for perforated peptic ulcer. A retrospective study. Chir Ital. 2005;(3):317–22.
23.
Bertleff M, Halm J, Bemelman W, Van Der Ham A, Van Der Harst E, Oei H, et al. Randomized clinical trial of laparoscopic versus open repair of the perforated peptic ulcer: the LAMA Trial. World Journal of Surgery. 2009;(7):1368–73.
24.
Samardzic J, Latic A, Hreckovski B, Latic F, Krizanovic -Rupcic A. Perforated Peptic Ulcers: Open and Laparoscopic Repair. Our Experience AIM. 2010;(4):226–8.
25.
Aziz F. Surgical Treatment of Perforated Peptic Ulcer. Chief Editor: Geibel J.
26.
Lunevicius R, Morkevicius M. Management strategies, early results,benefits, and risk factors of laparoscopic repair of perforated peptic ulcer. World J Surg. 2005;(10):1299–310.
27.
Schmidt H, Lange J, Nikolai J. Perforated Peptic Ulcer: new insights. Erasmus Universitet Roterdam. 2011;71–89.
28.
Turner W, Jr, Thompson W, Jr, Thal E. Perforated gastric ulcers. A plea for management by simple closures. Arch Surg. 1988;(8):960–4.
29.
Chiarugi M, Buccianti P, Goletti O, Decanini L, Sidoti F, Cavina E. Prognostic risk factors in patients operated on for perforated peptic ulcer. A retrospective analysis of critical factors of mortality and morbidity in a series of 40 patients who underwent simple closure surgery. Ann Ital Chir. 1996;(5):609–13.
30.
Tsugawa K, Koyanagi N, Hashizume M, Tomikawa M, Akahoshi K, Ayukawa K, et al. The therapeutic strategies in performing emergency surgery for gastroduodenal ulcer perforation in 130 patients over 70 years of age. Hepatogastroenterology. 2001;(37):156–62.
31.
Madiba T, Nair R, Mulaudzi T, Thomson S. Perforated gastric ulcer-reappraisal of surgical options. S Afr J Surg. 2005;(3):58–60.
32.
Kumar K, Pai D, Srinivasan K, Jagdish S, Ananthakrishnan N. Factors contributing to releak after surgical closure of perforated duodenal ulcer by Graham’s Patch. Trop Gastroenterol. 2002;(4):190–2.
33.
Kujath P, Schwandner O, Bruch H. Morbidity and mortality of perforated peptic gastroduodenal ulcer following emergency surgery. Langenbecks Arch Surg. 2002;(7–8):298–302.

Citation

Article metrics

Google scholar: See link

The statements, opinions and data contained in the journal are solely those of the individual authors and contributors and not of the publisher and the editor(s). We stay neutral with regard to jurisdictional claims in published maps and institutional affiliations.