Perforated peptic ulcer: a clinical study at Shri. Shankaracharya institute of medical sciences Bhilai, Chhattisgarh
DOI:
https://doi.org/10.18203/2349-2902.isj20233335Keywords:
Peptic ulcer disease, Perforated, APCHE 2 score, Abdominal pain, SmokingAbstract
Background: Perforation is a serious complication of PUD and patients with perforated peptic ulcer often carries high risk for morbidity and mortality. Acute perforated peptic ulcer is a leading cause of generalized peritonitis and its management has continued to be a challenging task in moderate resource setting environment. Aim and objective was to evaluate the different pattern of risk factors, clinical presentations, management and clinical outcome of patients with acute perforated peptic ulcer.
Methods: This was a hospital based prospective observational study conducted in the Department of general surgery at Shri Shankaracharya Institute of Medical Sciences, Bhilai, Chhattisgarh. Total of 79 cases with diagnosis of perforated peptic ulcer treated were taken as sample size. A specially designed proforma was used to collect information on patients' demographics, symptoms, complications, duration of hospital stay and treatment outcome.
Results: In present study male predominance was seen in peptic perforation cases 68.75% and M:F ratio was 2.2:1. Mortality rate was 17.71%. Mean hospital stay among survivors was 11.8 days and among non survivors 5.5±3.73 days. Most common risk factor seen was alcohol, smoking, peptic ulcer disease and NSAIDs ingestion. Whereas the most common presentation was abdominal pain, signs of peritonitis, abdominal distension. Cases with APCHE 2 score >21 had 90% mortality.
Conclusions: The present study conclude that perforated PUD is a life-threatening disease with high morbidities and mortalities. Male predominance, smoking and alcohol consumption and pain in abdomen were the common characteristics. APACHE 2 score was useful in assessing the risk of mortality.
References
Zelickson MS, Bronder CM, Johnson BL, Camunas JA, Smith DE, Rawlinson D, et al. Helicobacter pylori is not the predominant etiology for peptic ulcers requiring operation. Am Surg. 2011;77:1054-60.
Zittel TT, Jehle EC, Becker HD. Surgical management of peptic ulcer disease today--indication, technique and outcome. Langenbecks Arch Surg. 2000;385:84-96.
Bertleff MJ, Lange JF. Perforated peptic ulcer disease: a review of history and treatment. Dig Surg. 2010;27: 161-9.
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. Digestion. 2011;84:102-13.
Bas G, Eryilmaz R, Okan I, Sahin M. Risk factors of morbidity and mortality in patients with perforated peptic ulcer. Acta Chir Belg. 2008;108:424-7.
Vaira D, Menegatti M, Miglioli M. What is the role of Helicobacter pylori in complicated ulcer disease? Gastroenterology. 1997;113:S78-84.
Windsor JA, Hill AG. The management of perforated duodenal ulcer. Nz Med J. 1995;108:47-8.
Kang JY, Elders A, Majeed A, Maxwell JD, Bardhan KD. Recent trends in hospital admissions and mortality rates for peptic ulcer in Scotland 1982-2002. Aliment Pharmacol Ther. 2006;24:65-79.
Schubert ML, Peura DA. Control of gastric acid secretion in health and disease. Gastroenterology. 2008;134:1842-60.
Sonnenberg A, Müller-Lissner SA, Vogel E, Schmid P, Gonvers JJ, Peter P, et al. Predictors of duodenal ulcer healing and relapse. Gastroenterology. 1981;81: 1061-7.
Vergara M, Catalán M, Gisbert JP, Calvet X. Meta-analysis: role of Helicobacter pylori eradication in the prevention of peptic ulcer in NSAID users. Aliment Pharmacol Ther. 2005;21:1411-8.
Obonna GC, Obonna MC. Peptic ulcer perforation: experience in the riverine south western Nigeria. Trop J Med Med Sci. 2020;1(1):1-7.
Dongo AE, Uhunmwagho O, Kesieme EB, Eluehike SU, Alufohai EF. A Five-year review of perforated peptic ulcer disease in Irrua, Nigeria. Int Schol Res. 2017.
Dongo AE, Uhunmwagho O, Kesieme EB, Eluehike SU, Alufohai EF. A Five-Year Review of Perforated Peptic Ulcer Disease in Irrua, Nigeria. Int Sch Res Notices. 2017;2017:8375398.
Afuwape O, Irabor DO, Ayandipo O. An audit of perforated peptic ulcer disease in a tropical teaching hospital. East Central Afr J Surg. 2013;18(3):40-4.
Chalya PL, Mabula JB, Koy M, Mchembe MD, Jaka HM, Kabangila R, et al. Clinical profile and outcome of surgical treatment of perforated peptic ulcers in Northwestern Tanzania: A tertiary hospital experience. World J Emerg Surg. 2011;6:31.
Stabile BE, Passaro Jr E. Duodenal ulcer: a disease in evolution. Curr Surg. 1984;21(1):4-79.
Türkdoğan MK, Hekim H, Tuncer I, Aksoy H. The epidemiological and endoscopic aspects of peptic ulcer disease in Van region. East J Med. 1999;4(1):6-9.
Al-Marsoumi AM, Jabbo NS. Risk factors in perforated peptic ulcer disease: Incidence and relation to morbidity and mortality. Must Med J. 2013; 12(1):32-8.
Ugochukwu AI, Amu OC, Nzegwu MA, Dilibe UC. Acute perforated peptic ulcer: on clinical experience in an urban tertiary hospital in south east Nigeria. Int J Surg. 2013;11(3):223-7.
Kocer B, Surmeli S, Solak C, Unal B, Bozkurt B, Yildirim O, et al. Factors affecting mortality and morbidity in patients with peptic ulcer perforation. J Gastroenterol Hepatol. 2007;22(4):565-70.
Arveen S, Jagdish S, Kadambari D. Perforated peptic ulcer in South India: an institutional perspective. World J Surg. 2009;33(8):1600-4.
Rohit DK, Verma RS, Pandey G. Clinical study and management of peritonitis secondary to perforated peptic ulcer. Int Surg J. 2017;4:2721-6.
Ekka NMP, Malua S. Clinical study of peptic ulcer perforation in eastern India : an tertiary institution-based study. Int J Med Sci Public Heal. 2016;5(12): 2540-4.
Schein M, Saadia R, Jamieson J, Decker GA. Perforated gastric ulcers. A retrospective study of 32 patients. Am Surg. 1986;52(10):551-4.
Kulkarni P, Bhavimani G, Javalgikar A and Mahurkar N. Evaluation of melatonin and coenzyme Q10 for gastroprotective effect in aspirin and ibuprofen induced gastric ulcers in rats. Int J Pharm Sci Res. 2020;11(4):1802-7.
Singh R, Madan HK, Tayade SH. A prospective study of prediction of outcomes in perforative peritonitis using apache II scoring system. Int Surg J. 2017; 4(8):2648-52.
