ABSTRACT
A 25 year old man presented three days after an episode of blunt trauma abdomen (cycle handle injury) with complaint of abdominal pain and vomiting.At admission he had tachycardia, tenderness in epigastrium, and increase serum amylase. USG showed pancreatic swelling and free fluid in abdomen. CECT abdomen could not be performed. Exploratory laparotomy revealed pancreatic injury with slough. Capsulorrhaphy with drainage of lesser sac was done. Postoperatively he did not relieved, then CECT abdomen done on 8th postoperative day showed transaction of pancreas at neck. Relaparotomy with necrosectomy with drainage was done on next day. Distal pancreatectomy could not be performed due to edema. Patient was discharged with drain in situ draining 400 ml of clear fluid and again operated 2 months later. Distal pancreatectomy with splenectomy was done, patient was discharged uneventfully.
ABSTRACT
It is believed that Helicobacter pylori (H. Pylori) plays an important role in the causation of peptic ulcer. However, its role in duodenal ulcer perforation (DUP) has not been investigated extensively and the results are conflicting. The aim of this study was to determine the prevalence of H. pylori in patients with DUP patients as compared to normal healthy volunteers (NHV). Eighty-six consecutives patients with DUP and 30 NHV were included in the study. The NHV, drawn from the Surgery outpatient, were subjected to upper gastrointestinal (UGI) endoscopy and multiple gastric mucosal biopsies. Gastric mucosal biopsies among patients with DUP were obtained during laparotomy by passing a biopsy forcep through the perforation site. Biopsy specimens were put in urea broth for the rapid urease test (RUT), brucella broth (used as a transport medium) for culture and 10% formalin for histopathology. The results were analysed as the percentage of positive cases. The mean (+/-SD) age of patients with DUP (39.4+/-15.5 years) and of the NHV (36.0+/-13.9 years) were comparable (p= 0.290). Sixty-one (70.9%)patients with DUP had used NSAIDs prior to perforation. Only 7 patients with DUP (8.14%) had a past history of symptoms of duodenal ulcer and had been treated for it. A positive history of smoking, alcoholism and tobacco use was present in 68 (78.9%), 59 (68.6%) and 41(47.7%) patient with DUP, respectively. No culture was positive. Histology was positive for H. pylori in 29 patients with DUP and in 2 (6.7%)NHV. RUT was positive for H. pylori in 43(50%) patients with DUP and 5 NHV (16.7%). The present study documented a markedly higher association of H. Pylori infection with perforated duodenal ulcer.