Clinical and Therapeutic Aspects of Perforated Peptic Ulcer in Joseph Ravoahangy Andrianavalona University Hospital Center
Science Journal of Clinical Medicine
Volume 8, Issue 6, November 2019, Pages: 66-71
Received: Dec. 4, 2019;
Accepted: Dec. 20, 2019;
Published: Jan. 4, 2020
Views 291 Downloads 133
Solonirina Davida Rakotomena, Faculty of Medicine, University of Antananarivo, Antananarivo, Madagascar
Sedera Arimino, Faculty of Medicine, University of Antananarivo, Antananarivo, Madagascar
Medyno Mampiadana Lovasoa, Faculty of Medicine, University of Antananarivo, Antananarivo, Madagascar
Tianarivelo Rajaonarivony, Faculty of Medicine, University of Antananarivo, Antananarivo, Madagascar
Hery Nirina Rakoto Ratsimba, Faculty of Medicine, University of Antananarivo, Antananarivo, Madagascar
Despite the introduction of H2 receptor and proton pump antagonists into the therapeutic arsenal of the Peptic Ulcer Disease, gastric perforation remains the most common surgical emergery for the upper gastrointestinal tract. The present study aims to describe the particularities of the management of Perforated Peptic Ulcer which underwent surgery in the University Hospital Center Joseph Ravoahangy Andrianavalona Antananarivo (CHU-JRA) and to identify its morbidity and mortality factors. This is a retrospective analysis performed over a period of 33 months from January 2017 to September 2019 on Perforated Peptic Ulcer operated in CHU-JRA. Demographic, clinical and therapeutic parameters were studied and analyzed in relation to the morbidity and mortality rate. Altogether 158 patients operated for perforated Gastric or Duodenal Ulcer were included with an age ranging from 16 to 78 years old, a mean age of 39.05±15.03 years and a Sex Ratio estimated to 18.75. Repeated unexplored epigastralgia was noted in 70.89% of cases and 33.54% of patients used NSAIDs and/or corticosteroids before the onset of the pain. At admission, 9.4% of cases were immediately in shock. A laparotomy for exploration and repair was performed for a suspicion of a hollow-organ perforation on a X-ray of an Unprepared Abdomen. Antral perforation predominated in our serie (75.95%) and the main repair procedure consisted in a simple surgical suture. To conclude, our stude reflects the difficulty of the management of Peptic Ulcer Disease and its complications in our daily practice. Strenghtening the awareness of the population about the potiential severity of this disease is essential.
Solonirina Davida Rakotomena,
Medyno Mampiadana Lovasoa,
Hery Nirina Rakoto Ratsimba,
Clinical and Therapeutic Aspects of Perforated Peptic Ulcer in Joseph Ravoahangy Andrianavalona University Hospital Center, Science Journal of Clinical Medicine.
Vol. 8, No. 6,
2019, pp. 66-71.
Laine L, Takeuchi K, Tarnawski A. Gastric mucosal defense and cytoprotection: bench to bedside. Gastroenterology 2008; 135 (1): 41-60.
AGUSTIN, Esthiningrum Dewi; PUTRO, Mamiek Dwi; PURBAYU, Herry. Characteristic of Patients with Gastric Perforation due to Peptic Ulcer in Dr. Soetomo General Hospital Surabaya in the Period of January – December 2016. JBN (Jurnal Bedah Nasional), [S. I.], v. 3, n. 2, p. 45-49, sep. 2019.
Gulzar JS, Paruthy SB, Arya SV. Improving outcome in perforated peptic ulcer emergency surgery by Boey scoring. Int Surg J 2016; 3 (4): 2120-2128.
Hemmer PH, de Schipper JS, van Etten B, Pierie JP, Bonenkamp JJ, de Graaf PW, Karsten TM. Results of surgery for perforated gastroduodenal ulcers in a Dutch population. Dig Surg 2011; 28: 360-366.
Rakotomavo FA, Riel AM, Rakotoarison RCN, Randrianambinina H, Randrianambinina T, Randriamiarana MJ. Péritonite aigue: aspects épidémio-clinique et étiologique dans un des urgences chirurgicales malgache. A propos de 60 cas. Journal Africain d’Hépato-Gastroentérologie 2012; 6; 1: 33-67.
Hata T, Sakata N, Kudoh K, Shibata C, Unno M. The best surgical approach for perforated gastric cancer: one-stage vs. two-stage gastrectomy. Gastric Cancer 2014; 17 (3): 578-587.
Bardhan KD, Williamson M, Royston C, Lyon C. Admission rates for peptic ulcer in the Trent region, UK, 1972–2000. Changing pattern, a changing disease ? Dig Liver Dis 2004; 36 (9): 577-588.
Rajesh TR, Santhosh TV. Non-traumatic gastric perforations. J. Evid. Based Med. Healthc 2019; 6 (6): 327-330.
Janik J, Chwirot P. Perforated peptic ulcer time trends and patterns over 20 years. Med Sci Monit 2000; 6: 369-372.
Gökakin AK, Atabey M, Koyuncu A, Topcu O. Peptic Ulcer Perforation in Elderly: 10 years’ experience of a single institution. International Journal of Gerontology. 2016; 10: 198-201.
Lohsiriwat V, Prapasrivorakul S, Lohsiriwat D. Perforated peptic ulcer: clinical presentation, surgical outcomes, and the accuracy of the Boey scoring system in predicting postoperative morbidity and mortality. World J Surg 2009; 33 (1): 80-85.
Chandra SS, Siva Kumar S. Definitive or conservative surgery for perforated gastric ulcer ? - An unresolved problem. International Journal of Surgery 2009; 7: 136-139.
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 (2): 102-113.
Krobot K, Yin D, Zhang Q, Sen S, Altendorf-Hofmann A, Scheele J, Sendt W. Effect of inappropriate initial empiric antibiotic therapy on outcome of patients with community-acquired intra-abdominal infections requiring surgery. Eur J Clin Microbio Infect Dis 2004; 23 (9): 682-7.
Tran B-K, Groebli Y, Desbaillet YE, Della Santa V. Abdomen aigu chez la personne âgée aux urgences. Rev Med Suisse 2012; 8: 1548-1552.
Chang C, Wang SS. Acute abdominal pain in the elderly. Int J Gerontol 2007; 1: 77-82.
Christensen S, Riis A, Nørgaard M, Sørensen HT, Thomsen RW. Short-term mortality after perforated or bleeding peptic ulcer among elderly patients: a population-based cohort study. BMC Geriatr 2007; 7: 8.
Vashistha N, Singhal D, Makkar G, Chakravarty S, Raj V. Management of giant gastric ulcer perforation: report of a case and review of the literature. Case Reports in Surgery 2016; doi: 10.1155/2016/468198, 3 pages.
Hainaux B, Agneessens E, Bertinotti R, De Maertelaer V, Rubesova E, Moschopoulos C. Accuracy of MDCT in predicting site of gastrointestinal tract perforation. American Journal of Roentgenology, 2006; 187 (5): 1179–1183.
Leeman MF, Skouras C, Paterson-Brown S. The management of perforated gastric ulcers. International Journal of Surgery. 2013; 11: 322-324.
Bertleff MJ, Halm JA, Bemelman WA, Van Der Ham AC, Van Der Harst E, Oei HI, Smulders JF, Steyerberg EW, Lange JF. Randomized clinical trial of laparoscopic versus open repair of the perforated peptic ulcer: the LAMA Trial. World J Surg 2009; 33: 1368-1373.
Lunevicius R, Morkevicius M: Systematic review comparing laparoscopic and open repair for perforated peptic ulcer. Br J Surg 2005; 92: 1195-1207.
Siu WT, Leong HT, Law BK, Chau CH, Li AC, Fung KH, Tai YP, Li MK. Laparoscopic repair for perforated peptic ulcer: a randomized controlled trial. Ann Surg 2002; 235: 313-319.
Kocer B, Surmeli S, Solak C, Unal B, Bozkurt B, Yildririm O, Dolapci M, Cengiz O. Factors affecting mortality and morbidity in patients with peptic ulcer perforation. Journal of Gastroenterology and Hepatology 2007; 22: 565-570.
Turner WW Jr, Thompson WM Jr, Thal ER. Perforated gastric ulcers. A plea for management by simple closures. Arch Surg 1988; 123 (8): 960-964.
Messager M, Sabbagh C, Denost Q, Regimbeau JM, Laurent C, Rullier E, Sa Cunha A, Mariette C. Quel intérêt au drainage abdominal prophylactique en chirurgie digestive élective majeure ? Journal de Chirurgie Viscérale 2015; 152: 316-326.
Slim K. Fast-tracking en postopératoire: chasse aux sondes, marche et alimentation précoce. Anesth Reanim 2015; 1: 429-434.
Møller MH, Shah K, Bendix J, Jensen AG, Zimmermann-Nielsen E, Adamsen S, Møller A. Risk factors in patients surgically treated for peptic ulcer perforation. Scand J Gastroenterol 2009; 44: 145-152.
Taş İ, Ulger BV, Önder A, Murat Kapan M, Zübeyir Bozdağ Z. Risk factors influencing morbidity and mortality in perforated peptic ulcer disease. Ulus Cerrahi Derg 2014; 31: 20-25.