To explicate the need for biopsy in spontaneous gastric ulcer perforation

Hussain Gohar; Manoj Kela; Arpita Chouhan; Sakshi Meena; Nimisha Jain

doi:10.18203/2349-2902.isj20253837

Authors

Hussain Gohar Sri Aurobindo Institute of Medical Sciences and PG Institute, Sri Aurobindo University, Indore, India
Manoj Kela Department of General Surgery Sri Aurobindo Institute of Medical Sciences and PG Institute, Sri Aurobindo University, Indore, India
Arpita Chouhan Department of General Surgery Sri Aurobindo Institute of Medical Sciences and PG Institute, Sri Aurobindo University, Indore, India
Sakshi Meena Department of General Surgery Sri Aurobindo Institute of Medical Sciences and PG Institute, Sri Aurobindo University, Indore, India
Nimisha Jain Department of General Surgery Sri Aurobindo Institute of Medical Sciences and PG Institute, Sri Aurobindo University, Indore, India

DOI:

https://doi.org/10.18203/2349-2902.isj20253837

Keywords:

Peptic ulcer disease, Gastric ulcer perforation, Intraoperative biopsy, Histopathology, Malignancy, Emergency surgery

Abstract

Background: Peptic ulcer disease (PUD) remains a significant global health burden, with perforation being one of its most severe complications, associated with high morbidity and mortality. Although most perforated gastric ulcers are benign, a considerable minority harbor malignancy, which may be difficult to detect intraoperatively due to inflammation and tissue destruction. Routine biopsy during surgery may aid in identifying malignancy and guiding further management.

Methods: This retrospective study was conducted at Sri Aurobindo College and PG Institute between March 2025 and April 2025. Twenty-five patients who underwent emergency surgery for spontaneous gastric ulcer perforation were included. Biopsies were obtained from ulcer edges and adjacent mucosa, preserved in formalin, and examined histopathologically. Patient demographics, risk factors, intraoperative findings, and outcomes were analyzed.

Results: The study population had a mean age of 49.5 years, with 70% being male. Most perforations were small (≤1 cm) and were repaired using the Modified Graham’s Patch technique. Histopathological examination revealed carcinoma in 4 patients (16%), while 21 patients (84%) showed only benign inflammatory or fibrotic changes. Identified risk factors included alcohol use (8%), tobacco use (20%), and combined alcohol-tobacco use (4%). All patients survived the operative procedures.

Conclusion: A clinically significant proportion of spontaneous gastric ulcer perforations are associated with carcinoma. Routine intraoperative biopsy is recommended to avoid missed diagnoses and enable timely oncological intervention. Incorporating standardized biopsy protocols into surgical management can improve diagnostic accuracy and patient outcomes.

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