Retrospective Analysis of Patients Operated for Peptic Ulcer Perforation: Single Center Results
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This report is based on a study of 514 cases of perforated peptic ulcer. Follow-up data were obtained for periods ranging from less than a year to more than 22 years in 285 of the 449 cases in which the patients survived simple closure of the perforation. In 101(35.5 per cent) of these 285 cases, the patients were free of symptoms when they were last seen. Ulcer symptoms persisted or recurred in 166 (58.2 per cent) of the 285 cases, and an operation was performed later in 110 of these 166 cases.
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Objective: To investigate the clinical characteristics and the treatment of elderly peptic ulcer. Methods:143 cases of elderly patients with peptic ulcer diagnosed by endoscopy were analyzed retrospectively. Results: Among 143 cases of elderly patients, 38 cases of typical regularity abdominal pain(26.57%), 53 cases of atypical symptoms(37.06%), 62 cases of totally asymptomatic(43.36%). Gastric perforation occurred in 5 cases(3.50%), 21 cases of upper gastrointestinal bleeding(14.69%), 7 cases of pyloric obstruction(4.90%). Conclusion: Elderly peptic ulcer abdominal with pain symptoms in non-law, and the merger of digestive tract bleeding, perforation and other complications, should be payed a high degree of clinical attention, losers of active conservative treatment should be given surgical treatment to avoid bleeding and other life-threatening complications.
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To explore and analyze the current status in management of patients with perforated peptic ulcers (PPU).A retrospective study carried out at the Surgical Department, Al-Gamhouria Teaching Hospital, Aden, Yemen. Patients admitted with perforated benign peptic ulcers from January 1997 to December 2006 were included in the study.A total of 156 patients, 138 (88.5%) male and 18 (11.5%) female, with an overall mean age of 39.08 years (range 14-75 years) and a higher frequency of PPU was noted in patients 21-40 years (58.3%). The perforated duodenal ulcer and perforated gastric ulcer ratio was 4.38:1. The mean time of presentation was 16.5 hours, and operative intervention after admission was 5.25 hours. Simple perforation closure was used in 91.7% of the patients. Postoperative complication rate was 41% (statistically significant in cases admitted later than 12 hours), wound sepsis making the majority at 55.2%, 6 deaths (3.9%), the correlation with presentation time was not significant. The overall mean post-operative hospitalization period was 12.76 days; 14.7% of the patients stayed more than 3 weeks.Younger patients (21-40 years) were frequently affected. Emphasis should be placed on shortening the time to surgery. Simple closure remains the selected treatment in the majority of patients. Overall post-operative mortality was low (3.9%). Improving the surgical skills, wound care, administrative regulations, hospital environment, and equipment are needed to reduce the high rate of complications.
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Objective:To explore the curative method and indication of non-operative treatment for the peptie ulcer with acute performation.Methods:The clinical data of patients diagnosed as peptic ulcer with acute perforation were analyzed retrospectively.Results:The curative effect of non-operative treament was all right.Two patients were complicated by abscess of abdominal cavity.Average time in hospital was 9.6 days.The ulcers in all cases treated with adequate trial of medical drug for a course of treatment after discharge were healing by gastroscopy.21 cases were followed up from 6 to 12 months,and the curative effect was satisfactory.Conclusion:Non-operative treatment for peptic ulcer with early acute perforation as fasting in young patients may be adopted.During non-opertive treatment,if inflammatory response becomes worse,opertive treatment should be performed immediately.
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Abstract The results of simple closure were compared with those of partial resection in the treatment of perforated peptic ulcer. The investigation was carried out 7–13 years after the primary operation on 126 patients who had been allotted to one of the two treatment methods on the basis of an almost randomized schedule. Better late results were obtained with partial resection than with simple closure in patients in the age range 50–59 years at operation, with short duration of perforation and with a long history of symptoms before perforation. None of the patients treated with partial resection later underwent surgical treatment for recurrence of symptoms. In the simple closure group 27·3 per cent needed further surgery at 3 months to 10 years after perforation.
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The results of surgical treatment of perforated peptic ulcers in 330 patients, during the 12 year period from October 1989 to September 2001, were analysed. One hundred and ninety two patients were treated by simple closure and 138 patients by definitive surgery. There were no differences in age incidence, occupation, state of shock upon admission and duration of symptoms between the two groups. Complication rates were 30.21 and 19.57 per cent in simple closure and the definitive surgery group respectively. Mortality rate was 1.56 per cent in simple closure and no death in the definitive surgery group. Thirty-four patients in the simple closure group required definitive surgery subsequently for repeated perforation. It may be concluded that, except for perforation of acute duodenal ulcer, definitive surgery should be the treatment of choice in patients with a perforated peptic ulcer. Parameters used to decide whether to perform definitive surgery include the patient's condition and experience of the surgeon and surgical team.
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In a prospective study aimed at evaluating a safe treatment for perforated peptic ulcer in tropical African conditions 205 patients who presented with perforation of a peptic ulcer in South-Eastern Nigeria during the ten year period January 1973 to December 1982 were treated by simple suture. The ulcers were classified at operation from appearance and feel as acute in 155 patients (75.6%), and chronic in the remaining 50 patients (24.4%). Of this number 21 patients (10.2%) died post-operatively. All 21 patients had chronic pyloroduodenal ulcers which were complicated by haemorrhagic in 10 patients (5.0%) and extensive scarring of the duodenum and pyloric stenosis in 9 patients (4.4%). By way of contrast, no patient with acute pyloroduodenal ulcer died and none was known to suffer from recurrent dyspepsia at 6 months to 1 year follow-up. These results clearly show that simple suture is adequate and safe treatment for perforated acute pyloroduodenal ulcer; however, this form of treatment carries an unacceptably high mortality in those patients with perforated chronic pyloroduodenal ulcers. These patients should, where feasible, be treated by definitive ulcer - curative surgery.
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This is a retrospective analysis of 99 patients with perforated peptic ulcer treated in the Department of Surgery at the J. G. Strijdom Hospital over a 6-year period. The incidence of this condition is increasing in our population. The mortality rate for perforated peptic ulcer remains high (12.1%). Forty-three per cent of our patients were suffering from a major medical illness at the time of perforation, with a mortality rate of 25.6%. The mortality rate for relatively fit patients was 1.8%. While more conservative surgery is indicated for high-risk patients, a definitive ulcer operation can be performed safely in patients who are not suffering from a major medical illness. Our selective operative policy is discussed.
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