Resultados del tratamiento de la úlcera péptica perforada / Treatment of performed peptic ulcer: results

INTRODUCCIÓN. En nuestro hospital la úlcera péptica perforada tiene una elevada morbilidad y mortalidad, mayor del 20 por ciento en los últimos 5 años, lo que nos motivó a realizar este trabajo. MÉTODOS. Se realizó un estudio descriptivo y prospectivo de los pacientes tratados por úlcera péptica perforada en el Servicio de Cirugía General del Hospital Universitario Manuel Ascunce Domenech de Camagüey, durante los años 2006 y 2007. RESULTADOS. La úlcera péptica perforada predominó en los hombres entre 40 y 59 años de edad. El 41,2 por ciento tenían antecedentes de úlcera péptica, aunque solo la mitad recibía tratamiento médico. La mayoría de los pacientes fueron atendidos entre 13 y 24 h del inicio de su cuadro clínico, y hubo pocos casos de shock, deshidratación u otra enfermedad grave asociada. La úlcera duodenal perforada fue la más frecuente (67,6 por ciento) y la sutura y la epiploplastia fueron las técnicas quirúrgicas más usadas. La mortalidad fue del 5,9 por ciento, debida a falla múltiple de órganos y sepsis respiratoria grave. CONCLUSIONES. El índice de complicaciones y la mortalidad en nuestra serie fueron bajos, dada la adopción de medidas encaminadas a tratar adecuadamente el shock y las enfermedades graves asociadas, a disminuir el tiempo preoperatorio y a revisar las técnicas quirúrgicas empleadas, incluido el lavado peritoneal(AU)

INTRODUCTION: In our hospital, performed peptic ulcer has a high morbidity and mortality, greater than 20 percent during last 5 years, motivating us to perform this paper. METHODS: Authors made a prospective and descriptive study of patients treated by performed peptic ulcer in General Surgery Service of Manuel Ascunce Domenech University Hospital of Camaguey province during 2006 and 2007. RESULTS: Perforated peptic ulcer had a predominance in men aged between 40 and 59. The 41, 2 percent of them had backgrounds of peptic ulcer although only half received medical treatment. Most of patients were seen between 13 and 24 hours of clinical picture start, and there were few shock cases, dehydration or another associated severe disease. Perforated peptic ulcer was the more frequent (67, 6 percent) suture and epiploplasty, were the more used surgical techniques. Mortality was of 5,9 percent due to multiple organ failure and severe respiratory sepsis. CONCLUSIONS: Index of complications and mortality in our series were low, according to application of measures aimed to treat properly shock and the associated severe diseases, to decrease preoperative time, and to review surgical techniques used, including peritoneal lavage(AU)

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

Quality of life after peptic perforation.

AIM OF STUDY: Quality of life (QOL) as outcome during treatment of acid peptic disease has been studied, but, peptic perforation, which is the commonest complication of acid peptic disease, has not been studied in the light of QOL outcome. The present-study addresses the important issue of QOL after peptic perforations. METHODS: This prospective study was carried on 51 adult consecutive survivors of peptic perforation managed in Gastrointestinal Surgery Unit, Department of Surgery, Government NSCB Medical College and Hospital, Jabalpur (MP) India. These underwent exploratory laparotomy with repair of perforation, and subsequently were discharged on anti-ulcer therapy (Pantoprazole 40 mg once a day) for 6 weeks. The instrument chosen to study their QOL was gastrointestinal quality of life index (GIQLI). Patients were assessed before they underwent surgery and 3 months and 6 months after operation. RESULTS: The overall GIQLI score (t = 20.1, p < 0.00 at 3 months; t = 8.2, p < 0.001 at 6 months) as well as its G I core (t = 14.5, p < 0.001 at 3 months; t = 7.3, p < 0.001 at 6 months), G I disease specific (t = 12.9, p < 0.001 at 3 months; t = 2.6, p < 0.02 at 6 months), psychological (t = 15.4, p < 0.001 at 3 months; t = 3.5, p < 0.001 at 6 months) and physical and social components (t = 10.9, p < 0.001 at 3 months; t = 4.2, p < 0.001 at 6 months) significantly increased over 3 and 6 months of follow-up, reflecting improvement in quality of life as perceived by the patients. Variations in the pattern of recovery, based on age and gender were not seen in the present study. CONCLUSION: Peptic perforation does not result in any long lasting impairment of QOL and the QOL improves to near normal in 6 months time after the perforation.

Impact of ranitidine on prognosis after simple closure of perforated duodenal ulcer.

AIM: This randomized controlled study was carried out to evaluate the role of H2 receptor antagonists after simple closure of perforated duodenal ulcer. METHODS: A total of 192 patients who underwent simple closure for perforated duodenal ulcer were divided into two groups (A: study group and B: control group). Group A patients were treated with H2 receptor antagonists, while the patients in group B received placebo. Only 174 patients were available for endoscopic follow up. RESULTS: At the end of 24 weeks, only 6 patients out of 90 (6.6%) in group A as compared to 18 patients out of 84 (21.4%) in group B had persistent symptoms of ulcer disease as well as endoscopically proven ulcer (p < 0.05). CONCLUSIONS: The results indicate that H2 receptor antagonists have a definite role and endoscopic follow up is mandatory to define those cases who actually need definitive surgery.