TITLE

Mortality in Perforated Peptic Ulcer Patients After Selective Management of Stratified Poor Risk Cases

AUTHOR(S)
Rahman, M. Mizanur; Islam, M. Saiful; Flora, Sabrina; Akhter, S. Fariduddin; Hossain, Shahid; Karim, Fazlul
PUB. DATE
December 2007
SOURCE
World Journal of Surgery;Dec2007, Vol. 31 Issue 12, p2341
SOURCE TYPE
Academic Journal
DOC. TYPE
Article
ABSTRACT
Perforated peptic ulcer disease continues to inflict high morbidity and mortality. Although patients can be stratified according to their surgical risk, optimal management has yet to be described. In this study we demonstrate a treatment option that improves the mortality among critically ill, poor risk patients with perforated peptic ulcer disease. In our study, two series were retrospectively reviewed: group A patients ( n = 522) were treated in a single surgical unit at the Dhaka Medical College Hospital, Dhaka, Bangladesh during the 1980s. Among them, 124 patients were stratified as poor risk based on age, delayed presentation, peritoneal contamination, and coexisting medical problems. These criteria were the basis for selecting a group of poor risk patients ( n = 84) for minimal surgical intervention (percutaneous peritoneal drainage) out of a larger group of patients, group B ( n = 785) treated at Khulna Medical College Hospital during the 1990s. In group A, 479 patients underwent conventional operative management with an operative mortality of 8.97%. Among the 43 deaths, 24 patients were >60 years of age (55.8%), 12 patients had delayed presentation (27.9%), and 7 patients were in shock or had multiple coexisting medical problems (16.2%). In group B, 626 underwent conventional operative management, with 26 deaths at a mortality rate of 4.15%. Altogether, 84 patients were stratified as poor risk and were managed with minimal surgical intervention (percutaneous peritoneal drainage) followed by conservative treatment. Three of these patients died with an operative mortality of 3.5%. Minimal surgical intervention (percutaneous peritoneal drainage) can significantly lower the mortality rate among a selected group of critically ill, poor risk patients with perforated peptic ulcer disease.
ACCESSION #
27734072

 

Related Articles

  • Continuing Medical Education Questions: March 2013. DeVault, Kenneth R; Mehta, Paresh P; Albeldawi, Mazen; Kumaravel, Arthi; Macaron, Carole // American Journal of Gastroenterology;Mar2013, Vol. 108 Issue 3, p346 

    A continuing medical education quiz on mortality and comorbodity in patients suffering from peptic ulcer bleeding is presented.

  • Mortality in patients with bleeding peptic ulcer when those aged 60 or over are operated on early. Wheatley, K.E.; Snyman, J.H.; Brearley, S.; Keighley, M.R.B.; Dykes, P.W. // BMJ: British Medical Journal (International Edition);8/4/90, Vol. 301 Issue 6746, p272 

    Examines the mortality rate in patients with bleeding peptic ulcer undergoing early surgery in Great Britain. Role of endoscopic hemostasis on the improvement of surgery; Contributing factors to mortality; Common operations for duodenal ulcer and gastric ulcer.

  • Endothelin-1 in the Gastric Mucosa in Stress Ulcers of Critically Ill Patients. Michida, Tomoki; Kawano, Sunao; Masuda, Eiji; Kobayashi, Ichizo; Nishimura, Yoshiya; Tsujii, Masahiko; Takei, Yoshiyuki; Tsuji, Shingo; Nagano, Kouichi; Fusamoto, Hideyuki; Kamada, Takenobu; Sugimoto, Tsuyoshi // American Journal of Gastroenterology;Jul1997, Vol. 92 Issue 7, p1177 

    Objective: Gastric microcirculatory disturbances are involved in the pathogenesis of stress ulcers; however, vasomodulators causing this process are not fully understood. This study was conducted to investigate the role of endothelin 1 (ET-1), a potent vasoconstrictive peptide, in stress ulcers...

  • Peptik ülser perforasyonu ile karıştırılabilen rektosigmoid perforasyon: Olgu sunumu. Yavuz, Alper; Şeker, Duray; Buluş, Hakan; Aydın, Altan // Turkish Journal of Surgery / Ulusal Cerrahi Dergisi;2011, Vol. 27 Issue 4, p243 

    Spontaneos perforation of the colon is a rare condition. It is often seen in elderly patients and especially associated with chronic constipation. This disease has a high mortality rate. In contrast with the literature, in this article we report a spontaneous colonic perforation case in a young...

  • The Description of Outcomes in Medicare Patients Hospitalized With Peptic Ulcer Disease. Wen Xu; Hood, Hugh M.; Burgess, Patricia A. // American Journal of Gastroenterology;Jan2000, Vol. 95 Issue 1, p264 

    OBJECTIVE: The objective of this study was to describe outcomes of care for Medicare patients hospitalized with peptic ulcer disease from 1992 through 1997 and to identify factors related to cost, length of stay, and readmission rates. METHODS: General descriptive statistics were obtained from...

  • Predictors of rebleeding and mortality in patients with high-risk bleeding peptic ulcers. Chi-Liang Cheng; Cheng-Hui Lin; Chia-Jung Kuo; Kai-Feng Sung; Ching-Song Lee; Nai-Jen Liu; Jui-Hsiang Tang; Hao-Tsai Cheng; Yin-Yi Chu; Yung-Kuan Tsou; Cheng, Chi-Liang; Lin, Cheng-Hui; Kuo, Chia-Jung; Sung, Kai-Feng; Lee, Ching-Song; Liu, Nai-Jen; Tang, Jui-Hsiang; Cheng, Hao-Tsai; Chu, Yin-Yi; Tsou, Yung-Kuan // Digestive Diseases & Sciences;Sep2010, Vol. 55 Issue 9, p2577 

    Background and Aim: Patients with bleeding ulcers can have recurrent bleeding and mortality after endoscopic therapy. Risk stratification is important in the management of the initial patient triage. The aim of this study is to identify the clinical and laboratory risk factors for...

  • What is happening to peptic ulcer? Langman, M.J.S. // British Medical Journal (Clinical Research Edition);4/10/1982, Vol. 284 Issue 6322, p1063 

    Focuses on the decline in the frequency of peptic ulcer in Great Britain. Explanations for the changes in the occurrence of ulcers; Difficulty in defining reliable indices of ulcer frequency; Decrease of mortality and admission rates for gastric and duodenal ulcer.

  • Giant Prepyloric Ulcer Haemorrhage: Patient Characteristics, Treatment, and Outcome in 2003-2012. Peetsalu, Margot; Kirsimägi, Ülle; Peetsalu, Ants // Ulcers;2014, p1 

    The aim of the study was to characterize patients with giant prepyloric ulcer haemorrhage, their treatment, and outcome. The data for 929 peptic ulcer haemorrhage (PUH) patients were divided into three groups according to ulcer location: group I: 165 prepyloric ulcer patients, group II: 353...

  • Stopping the haemorrhage from peptic ulcers. Young, A.E. // British Medical Journal (Clinical Research Edition);2/20/1982, Vol. 284 Issue 6315, p530 

    Examines the haemorrhage from peptic ulcers. Treatment of the blood loss; Impact of somatostatin on gastrin release; Reduction of the blood flow in the coeliac axis.

Share

Read the Article

Courtesy of THE LIBRARY OF VIRGINIA

Sorry, but this item is not currently available from your library.

Try another library?
Sign out of this library

Other Topics