Úlcera marginal perforada post bypass gástrico laparoscópico / Perforated marginal ulcer after laparoscopic gastric bypass

Introduction: Perforated marginal ulcer is a serious event that usually requires reoperation and is associated with morbidity and mortality. Characterization and management of these patients is still debated. Objective: To describe a series of patients subjected to a laparoscopic gastric bypass (LGBP) that evolved with a perforated marginal ulcer. Material and Methods: Records of patients undergoing a LGBP the last 10 years and evolved with a perforated marginal ulcer were retrospectively reviewed. Clinical features, treatment and perioperative morbidity and mortality were analyzed. Results: During this period 2,095 patients were subjected to a LGBP, 12 of them presented a perforated marginal ulcer, corresponding to 10 women and 2 men. Mean age was 39 (21-60) and mean body mass index at the time of initial surgery was 34 (29.3 to 38.6). Ten patients were smoker at the moment of perforation. The occurrence of this happened at a mean of 27 months (range 3-54, median 23.5) after surgery. Eleven cases had a surgical resolution, with a laparoscopic approach in 9 of them and laparotomy on 2. In all cases, a perforated ulcer in the jejunal side of the gastro-jejunal anastomosis was found. There was no mortality or morbidity associated with surgery. Conclusions: In our experience the occurrence of perforated marginal ulcer after a LGBP develops in a small percentage of patients. The laparoscopic approach is of choice, presenting a low morbidity and mortality. Smoking was present in most patients.

Introducción: La perforación de una úlcera marginal es un evento grave que suele requerir una reoperación y se asocia a morbimortalidad. El manejo de estos pacientes es debatido y complejo. Objetivo: Describir una serie de pacientes operados de bypass gástrico laparoscópico (BPGLP) que evolucionaron con una úlcera marginal perforada. Material y Método: Se revisaron retrospectivamente las fichas de pacientes operados de BPGL los últimos 10 años y que evolucionaron con una úlcera marginal perforada. Se analizaron las características clínicas, de tratamiento y morbimortalidad perioperatoria. Resultados: Durante este período se operaron 2.095 pacientes de BPGLP, 12 de los cuales presentaron una úlcera marginal perforada, correspondientes a 10 mujeres y 2 hombres. El promedio de edad fue 39 años (21-60) y el índice de masa corporal (IMC) promedio al momento de la primera cirugía fue 34 (29,3-38,6). Diez pacientes tenían hábito tabáquico activo al momento de la perforación. La ocurrencia de esta sucedió en promedio a los 27 meses (rango 3-54, mediana 23,5) de la cirugía. En 11 casos la resolución fue quirúrgica, mediante abordaje laparoscópico en 9 y laparotomía en 2. En todos los casos se encontró una úlcera perforada en la vertiente yeyunal de la gastro-yeyuno anastomosis. No hubo mortalidad ni morbilidad asociada a la cirugía. Conclusiones: En nuestra experiencia la ocurrencia de úlcera marginal perforada post BPGLP se desarrolla en un bajo porcentaje de pacientes. El abordaje laparoscópico es de elección, presentando una baja morbimortalidad. El hábito tabáquico estuvo presente en la mayoría de los pacientes.

Fatal gastro-duodenal perforation following electrocution: A case report.

A 45 yrs old male was accidentally electrocuted, while cooking on a locally made heater in his home. He was immediately brought to the hospital in unconscious state by the family members. After first aid he was referred to a tertiary care hospital, where he was admitted about two hrs after the incident. On admission he was unconscious, abdomen was distended, with fluid in peritoneal cavity. There was tachycardia and hypotension. Bowel sounds were absent. Electrocution burn marks were present over the right hand. Arterial blood analysis showed severe metabolic acidosis. He was immediately shifted to the ICU. His condition continued to be critical with persistent metabolic acidosis despite repeated sodium bicarbonate infusion. An exploratory laprotomy was planned to rule out abdominal visceral injuries. However the patient expired six hrs after admission to the hospital before being taken to the operation theatre. Autopsy examination showed perforated anterior wall of stomach antrum and first part of duodenum.

Analysis of risk factors cotnributing to releak in duodenal ulcer perforation: experience of surgical closure by Graham's patch

Free perforation of peptic ulcer into the general peritoneal cavity is a catastrophic event. Although laparoscopic approach has been successfully used for its management, primary closure of the perforation using an omental patch [Grahm's patch] is the immediate alterative. This study was planned to analyse risk factors, which could predict releak following Grahm's patch closure. This study was carried out for five years from April 2003 to March 2008, at department of surgery Muhammad Medical College Mirpurkhas. All patients undergoing surgery for perforated duodenal ulcer were included in the study. 53 patients underwent Grahm's Patch Closure. 6 patients developed releakage post operatively. Therefore two groups were made. Patients with releak were kept in case group [n=6] and the patients with no leak [n=47] were included in control group. In this study all patients were assessed for age, pulse rate, systolic blood pressure, hemoglobin and serum Protein / albumin, total leukocyte count [TLC] on arrival, delay in arrival since sign and symptom [probable] of perforation and size of perforation on operation were also documented. Age greater than 50 years [p=0.05], pulse greater than 110/min [p=0.22], systolic blood pressure less then 90mmHg [p=0.02l], hemoglobin less than 10gm% [p=0.25], serum albumin less than 2.5gm% [p=0.018], delay in arrival for more then 36 hour [p=0.00017], and size of proportion greater then 5mm in it maximum dimension were identified as risk factor for releak. Delay in arrival was the single most significant factor influencing mortality rate after omental patch closure of perforated duodenal ulcer

Perforated Peptic Ulcer Disease at Kenyatta National Hospital; Nairobi

Background: Published reports on perforated peptic ulcers indicate increasing rates for the elderly; those chronically ill and females. Our local observations are at variance. This study analysed patients treated for peptic ulcer perforations at the Kenyatta National Hospital between January 2005 and December 2006. Methods: Clinical charts for patients admitted and treated for perforated peptic ulcer disease were reviewed. Data sought included patient demographic data; clinical presentation; and time from onset of symptoms to treatment; operative findings and treatment mplications. The determinants of post-operative complications were evaluated using univariate analysis. Results: Forty four patients with perforated ulcers were admitted and treated over a two year study period. Twenty eight were analyzed (retrieval rate 63.6). Males (86.2) and those 35 years of age and younger (57.1) predominated. Alcohol; smoking and prior use of non steroidal anti inflammatory drugs were respectively documented in 39.3; 39.3and 10.7of patients. The complication rate was 25. Four patients died. The factors significantly related to complications was treatment delay (p=0.007) and acute perforation (0.027) Conclusion: Perforated peptic ulcer disease is a disease of young males. Efforts to reduce delay in presentation in this population may reduce the complications

Risk factors in the causation of duodenal ulcer perforation in region of Southern Punjab

Despite the wide spread use of gastric antisecretory agents and eradication therapy, the incidence of perforation of duodenal ulcer remains more or less the same [5 10%]. There are certain well-defined risk factors that indicate, an increased liability to develop the disease The association of various probable risk factors such as H. Pylon, inadequate dietary intake, smoking, alcohol, ABO blood group and non-steroidal anti-inflammatory drugs has been studied. To evaluate the probable risk factors for perforation of duodenal ulcer, highlighting any prevalent one in the occurrence of perforation in our region. Study design:-Descriptive/Retrospective study. 3[rd] surgical unit Nishter Hospital Multan. Subjects:-All the patients having DU perforation were included. 62 patients with DU perforation were evaluated with special emphasis on etiological risk factors. Findings were recorded in the proforma and results obtained were compared with national and international studies. Stress, Smoking, NSAIDs and H. Pylori are the important factors in the causation of duodenal ulcer perforation. In our series stress is involved in 80% of cases. Followed by smoking [69%], H. Pylon [64%] and NSAIDs [55%]. Stress, smoking; H-Pylon infection and NSAIDS abuse are the factors in southern Punjab which cause perforation of duodenal ulcer

Ulcera perforada post crisis financiera 2002: aumento de incidencia en el Hospital Pasteur / Perforated ulcer subsequent to year 2002 finantial crisis: intensification of incidence at the Hospital Pasteur

Con el objetivo de demostrar el aumento de la incidencia de úlcera gastroduodenal perforada en el Hospital Pasteur y su relación con factores socio económicos, se analizó la frecuencia de esta patología en los últimos 40 meses, así como la evolución de los indicadores socio-económicos que sobrevinieron a partir de la crisis financiera del año 2002. Se operaron 86 pacientes desde 1/2000 hasta 4/2003, 70 (81,4 por ciento) hombres, con una edad promedio de 49 (16-84), destacando un aumento del 83,35 por ciento en el año 2002, respecto del año anterior, lo cual resultó ser estadísticamente significativo. El 36,5 por ciento de los pacientes no presentaba síntomas previos, siendo la perforación el debut de su enfermedad ulcerosa. Se muestra la tendencia negativa de múltiples indicadores socioeconómicos en la misma fecha y basados en la literatura sobre el tema, se demuestra una relación causal entre ambos.

Gastric Ulcer Perforation in Heart-Lung Transplant Patient: A Successful Case of Early Surgical Intervention and Management

Gastrointestinal complications may follow organ transplantation. A patient who underwent heart lung transplantation due to patent ductus arteriosus and Eisenmenger's syndrome had an episode of acute cardiac rejection and was treated with a bolus injection of methylprednisolone followed by a high oral dose of prednisone. On the 22nd postoperative day, the patient complained of acute abdominal pain with muscular rigidity and a plain chest x-ray showed free air in the right subdiaphragmatic area. Under the suspicion of bowel perforation, an emergency laparotomy was performed and the perforated stomach had a wedge-shaped resection that included the perforation. Following the laparotomy, the postoperative course was uneventful and the patient was discharged on post-laparotomy day 10.

Spontaneous duodenal perforation in a newborn.

A full-term 4-day-old male baby presented with spontaneous duodenal perforation into the lesser sac. Exploration revealed a perforation in the posteromedial wall of the second portion of the duodenum. The perforation was closed and the baby recovered uneventfully.

Association of Helicobacter pylori with peptic perforation in Chattisgarh region of India.

BACKGROUND: Helicobacter pylori is present in over 90% cases of peptic ulcer. There are very few reports regarding prevalence of H. pylori infection in peptic ulcer perforation which is the commonest complication of peptic ulcer disease. In the present study we have drawn this association. PATIENTS AND METHODS: 44 cases of peptic perforation were included in this study. Per-operative biopsy was taken from the margin of perforation. The criteria for H. pylori positivity were, Positive Rapid Urease Test and evidence of H. pylori infection on histological examination using Modified Giemsa and H&E stains. RESULTS: Prevalence of H. pylori infection in peptic perforation was 61.4%. This is well above the usual prevalence in normal population of 45%. H. pylori infection was significantly more common in cases of chronic dyspepsia (> 6 months) and not significantly related to sex, blood group, addiction, family history of acid peptic disease and previous H2 blocker therapy. INFERENCE: H. pylori is found more commonly in patients with peptic ulcer perforation than in those without.

Ulcera duodenal gigante / Giant duodenal ulcer

Se hace una revisión de la clínica, radiología, endoscopia, pronóstico y tratamiento médico y quirúrgico de la úlcera gigante del duodeno, la forma atípica más severa de la úlcera péptica. Se describe la perfusión continua de antagonistas H-2 de la secreción gástrica y se recomienda su uso previo al procedimiento quirúrgico

Complicaçöes do divertículo de Meckel / Complications of Meckel's diverticulum

Os autores relatam complicaçöes de divertículo de Meckel encontradas em oito pacientes que foram submetidos a cirurgia abdominal de emergência. O sangramento intestinal esteve presente em um paciente (12,5%), obstruçäo intestinal em três (37,5%) e processo inflamatório agudo em quatro (50,0%). Estas complicaçöes do divertículo manifestaram-se com quadros clínicos diversos e os diganósticos pré-operatórios incluíram abdome agudo obstrutivo em dois (25,0%), obstruçäo intestinal por áscaris em um (12,5), úlcera péptica perfurada em um (12,5), apendicite aguda em três (37,5%) e enterorragia de causa a esclarecer em um (12,5%). Duas complicaçöes foram observadas no pós-operatório. Dentre os pacientes com diverticulite perfurada, houve a necessidade de reoperaçäo para drenagem de abscesso intraperitoneal em um paciente. Outro evoluiu com íleo paralítico prolongado, havendo necessidade de introduçäo de nutriçäo parenteral total. Nenhum paciente faleceu