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Kobayashi T, Hidaka E, Koganezawa I, Nakagawa M, Yokozuka K, Ochiai S, Gunji T, Sano T, Kikuchi Y, Tomita K, Shigoka M, Tabuchi S, Chiba N, Kawachi S. Scoring model for the diagnosis of colorectal perforation and its differentiation from gastroduodenal perforation. Surg Today 2025; 55:754-759. [PMID: 39438336 DOI: 10.1007/s00595-024-02949-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2024] [Accepted: 09/25/2024] [Indexed: 10/25/2024]
Abstract
PURPOSE Distinguishing colorectal from gastroduodenal perforations is clinically important and challenging. We aimed to establish a scoring model based on objective findings (excluding computed tomography findings) for the diagnosis of colorectal perforation and its differentiation from gastroduodenal perforation. METHODS Patients diagnosed with colorectal or gastroduodenal perforations between January 2014 and December 2021 were retrospectively studied. Univariate and multivariate analyses were performed to identify independent variables, and a scoring model was developed based on these variables. RESULTS Among 131 eligible patients, 64 (48.9%) were in the colorectal group and 67 (51.1%) were in the gastroduodenal group. White blood cell count, C-reactive protein, and quick Sequential Organ Failure Assessment score were identified as independent clinical variables associated with the diagnosis of colorectal perforation, which differentiated colorectal perforation from gastroduodenal perforation, and were used to develop a new scoring model. The scores ranged from 0 to 5, with an area under the receiver operating characteristic curve of 0.846. The probabilities of colorectal perforation with scores of 0, 1.5, 2, 3, 3.5, and 5 were 3.2, 20, 55.6, 81.8, 73.9, and 82.4%, respectively. CONCLUSION The new scoring model may help in treatment selection and perioperative management of patients with gastrointestinal perforation.
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Affiliation(s)
- Toshimichi Kobayashi
- Department of Digestive and Transplantation Surgery, Tokyo Medical University Hachioji Medical Center, 1163 Tatemachi Hachioji, Tokyo, 193-0998, Japan.
| | - Eiji Hidaka
- Department of Digestive and Transplantation Surgery, Tokyo Medical University Hachioji Medical Center, 1163 Tatemachi Hachioji, Tokyo, 193-0998, Japan
| | - Itsuki Koganezawa
- Department of Digestive and Transplantation Surgery, Tokyo Medical University Hachioji Medical Center, 1163 Tatemachi Hachioji, Tokyo, 193-0998, Japan
| | - Masashi Nakagawa
- Department of Digestive and Transplantation Surgery, Tokyo Medical University Hachioji Medical Center, 1163 Tatemachi Hachioji, Tokyo, 193-0998, Japan
| | - Kei Yokozuka
- Department of Digestive and Transplantation Surgery, Tokyo Medical University Hachioji Medical Center, 1163 Tatemachi Hachioji, Tokyo, 193-0998, Japan
| | - Shigeto Ochiai
- Department of Digestive and Transplantation Surgery, Tokyo Medical University Hachioji Medical Center, 1163 Tatemachi Hachioji, Tokyo, 193-0998, Japan
| | - Takahiro Gunji
- Department of Digestive and Transplantation Surgery, Tokyo Medical University Hachioji Medical Center, 1163 Tatemachi Hachioji, Tokyo, 193-0998, Japan
| | - Toru Sano
- Department of Digestive and Transplantation Surgery, Tokyo Medical University Hachioji Medical Center, 1163 Tatemachi Hachioji, Tokyo, 193-0998, Japan
| | - Yuji Kikuchi
- Department of Digestive and Transplantation Surgery, Tokyo Medical University Hachioji Medical Center, 1163 Tatemachi Hachioji, Tokyo, 193-0998, Japan
| | - Koichi Tomita
- Department of Digestive and Transplantation Surgery, Tokyo Medical University Hachioji Medical Center, 1163 Tatemachi Hachioji, Tokyo, 193-0998, Japan
| | - Masatoshi Shigoka
- Department of Digestive and Transplantation Surgery, Tokyo Medical University Hachioji Medical Center, 1163 Tatemachi Hachioji, Tokyo, 193-0998, Japan
| | - Satoshi Tabuchi
- Department of Digestive and Transplantation Surgery, Tokyo Medical University Hachioji Medical Center, 1163 Tatemachi Hachioji, Tokyo, 193-0998, Japan
| | - Naokazu Chiba
- Department of Digestive and Transplantation Surgery, Tokyo Medical University Hachioji Medical Center, 1163 Tatemachi Hachioji, Tokyo, 193-0998, Japan
| | - Shigeyuki Kawachi
- Department of Digestive and Transplantation Surgery, Tokyo Medical University Hachioji Medical Center, 1163 Tatemachi Hachioji, Tokyo, 193-0998, Japan
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Sokhal BS, Mohamedahmed AYY, Zaman S, Wuheb AA, Abdalla HE, Husain N, Hajibandeh S, Hajibandeh S. Laparoscopic versus open repair for peptic ulcer perforation: a systematic review, meta-analysis and trial sequential analysis of randomised controlled trials. Time to conclude! Ann R Coll Surg Engl 2025; 107:331-345. [PMID: 39361132 PMCID: PMC12043367 DOI: 10.1308/rcsann.2024.0082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/16/2024] [Indexed: 05/02/2025] Open
Abstract
INTRODUCTION The aim of this study was to investigate comparative outcomes of laparoscopic and open repair for peptic ulcer perforation (PUP). METHODS A PRISMA-compliant systematic review with a PROSPERO-registered protocol (registration number CRD42024529286) was conducted. All randomised controlled trials (RCTs) involving PUP patients managed by laparoscopic or open repair were identified and their risk of bias assessed. Outcome syntheses for perioperative mortality and morbidities, need for reoperation, procedure time and length of hospital stay were conducted using random-effects modelling to calculate risk ratios (RR) or mean difference (MD) with 95% confidence intervals (CI). FINDINGS Nine RCTs met the inclusion criteria, enrolling 670 patients of whom 317 were randomised to receive laparoscopic surgery and 353 were managed with open surgery. Laparoscopic repair of PUP significantly reduced mortality (RR 0.37, p = 0.03), total complications (RR 0.57, p = 0.0009), ileus (RR 0.43, p = 0.04), wound complications (RR 0.36, p < 0.0001) and length of hospital stay (MD -2.37, p = 0.0003) compared with the open approach. There were no significant differences in rate of postoperative leak (RR 2.00, 95% CI 0.74-5.41, p = 0.17), abdominal collection (RR 1.19, 95% CI 0.46-3.07, p = 0.72), sepsis (RR 1.17, 95% CI 0.39-3.52, p = 0.65), respiratory complications (RR 0.68, 95% CI 0.32-1.46, p = 0.32), reoperation (RR 1.74, 95% CI 0.57-5.30, p = 0.33) and operating time (MD 15.31, 95% CI -4.86 to 35.47, p = 0.14) between the two groups. CONCLUSIONS Laparoscopic repair of PUP is associated with significantly lower mortality and morbidity and shorter length of stay compared with the open approach. The laparoscopic approach should be the management of choice subject to the existence of laparoscopic expertise.
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Affiliation(s)
| | - AYY Mohamedahmed
- University Hospitals of Derby and Burton NHS Foundation Trust, UK
| | - S Zaman
- The Dudley Group NHS Foundation Trust, UK
| | - AA Wuheb
- Wirral University Teaching Hospital NHS Foundation Trust, UK
| | | | - N Husain
- University Hospitals of Derby and Burton NHS Foundation Trust, UK
| | | | - S Hajibandeh
- University Hospitals of North Midlands NHS Trust, UK
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Cardoso LJC, Martins KAM, Xavier PVM, Nascimento FGO, Gontijo PHG, Minkauskas JL, Faria IC, Abreu RDA, Rocha ALS, Del Aguila JWV. Safety and Efficacy of the Falciformopexy Technique for Peptic Ulcer Perforation: A Systematic Review and Meta-Analysis. Am Surg 2025; 91:859-870. [PMID: 39991919 DOI: 10.1177/00031348251323722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2025]
Abstract
ObjectivesPeptic ulcer perforation (PUP) is a severe complication of peptic ulcer disease, associated with significant morbidity and mortality. The Graham patch repair (GPR) is the standard surgical treatment; however, when the greater omentum is insufficient, falciformopexy has emerged as a viable alternative. This study aims to assess the efficacy and safety of falciformopexy for PUP through a systematic review and meta-analysis.MethodsA systematic search was conducted in PubMed, Scopus, Cochrane, Web of Science, and Ovid to identify studies reporting on PUP patients treated with falciformopexy. Outcomes evaluated included length of hospital stay, perioperative mortality, wound infections, and reoperation rates. A comparative analysis with patients treated with GPR was also performed. Safety and efficacy outcomes were analyzed using single proportions, while risk ratios (RR) with 95% confidence intervals were pooled for comparative assessments.ResultsSix studies involving 868 patients were included, of whom 148 underwent falciformopexy for PUP. The mean hospital stay was 8.76 days (95% CI: 6.5-11.02; I2 = 92%). The perioperative mortality rate was 4.38% (95% CI: 0%-10.26%; I2 = 53%), the wound infection rate was 6.66% (95% CI: 2.31%-11.02%; I2 = 0%), and reoperation was required in 1.76% of cases (95% CI: 0%-4.73%; I2 = 0%). Comparative analysis revealed no significant differences between the falciformopexy and GPR groups regarding mortality, wound infections, or reoperation rates.ConclusionThese results indicate that the use of the falciform ligament for PUP repair is associated with low perioperative mortality, wound infection, and reoperation rates, suggesting it is a viable alternative when the omentum is unavailable.
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Affiliation(s)
| | | | | | | | | | - Juan Lima Minkauskas
- School of Medicine, Faculty of Medicine, Federal University of Minas Gerais, Belo Horizonte, Brazil
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Gavriilidis P, Schena CA, Di Saverio S, Hromalik L, Eryilmaz M, Catena F, de'Angelis N. Alternative treatments to treat perforated peptic ulcer: a systematic review and network meta-analysis of randomized controlled trials. World J Emerg Surg 2025; 20:31. [PMID: 40217342 PMCID: PMC11987199 DOI: 10.1186/s13017-025-00599-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2025] [Accepted: 03/04/2025] [Indexed: 04/14/2025] Open
Abstract
INTRODUCTION Perforated peptic ulcers (PPU) represent a critical surgical emergency. Despite the historical predominance of open surgical repair, laparoscopic and endoscopic approaches have shown promise in reducing morbidity and hospital stay. This study aimed to conduct a network meta-analysis comparing open, laparoscopic, and endoscopic interventions for PPU repair. METHODS A systematic search of Medline (PubMed), Embase, Cochrane Library, Google Scholar, and the National Institute for Health and Clinical Excellence (NICE) databases identified randomized controlled trials (RCTs) comparing these approaches. The primary outcomes were 30-day mortality and morbidity. RESULTS Eight RCTs including 657 patients were analyzed. Endoscopic interventions were associated with fewer respiratory complications and shorter hospital stays, while the laparoscopic approach demonstrated fewer surgical site infections and less postoperative pain compared to open repair. Other outcomes demonstrated non-significant differences across interventions. CONCLUSIONS Prompt resuscitation and surgical repair, either laparoscopic or open, remains the gold standard for PPU. Endoscopic techniques are viable alternatives for small perforations and in selected cases where general anesthesia is contraindicated.
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Affiliation(s)
- Paschalis Gavriilidis
- Department of Surgery, Wexner Medical Center, The Ohio State University, Columbus, OH, 43210, USA
| | - Carlo Alberto Schena
- Unit of Robotic and Minimally Invasive Digestive Surgery, Department of Surgery, Ferrara University Hospital Arcispedale Sant'Anna, 44124, Ferrara, Italy.
- Department of Translational Medicine and LTTA Centre, University of Ferrara, 44121, Ferrara, Italy.
| | - Salomone Di Saverio
- Department of General Surgery, University of Insubria, University Hospital of Varese, ASST Sette Laghi, Regione Lombardia, Italy
| | - Larry Hromalik
- Department of Trauma and Acute Care Surgery, Wexner Medical Centre, The Ohio State University, Columbus, OH, 43210, USA
| | - Mehmet Eryilmaz
- Department of Surgery, Gülhane Education & Training Hospital, Gülhane Medical Faculty, 06010, Ankara, Turkey
| | - Fausto Catena
- Department of General and Emergency General Surgery, Bufalini Hospital, Cesena, Italy
- University of Bologna, Bologna, Italy
| | - Nicola de'Angelis
- Unit of Robotic and Minimally Invasive Digestive Surgery, Department of Surgery, Ferrara University Hospital Arcispedale Sant'Anna, 44124, Ferrara, Italy.
- Department of Translational Medicine and LTTA Centre, University of Ferrara, 44121, Ferrara, Italy.
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Arshad SA, Murphy P, Gould JC. Management of Perforated Peptic Ulcer: A Review. JAMA Surg 2025; 160:450-454. [PMID: 39937493 DOI: 10.1001/jamasurg.2024.6724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/13/2025]
Abstract
Importance Perforated peptic ulcer disease (PUD) affects 4 million people annually worldwide, with a lifetime prevalence of 5% to 10%. Of those affected, 5% will progress to the point of perforation. Despite advances in the understanding and treatment, perforated PUD continues to have a high rate of morbidity (48.5%) and mortality (9.3%). This review summarizes the current evidence on management of perforated PUD, including management of failed repairs. Observations Approaches for repair include primary closure and omental patch closure. Omental patch may be most useful in large perforations with friable tissue. Minimally invasive surgery is the preferred approach in perforated PUD, with improved outcomes compared with open techniques. Leak from the ulcer after repair is seen in approximately 12% to 17% of cases. Approaches to releak include expectant management, radiologic and/or endoscopic intervention, and repeat surgery. Morbidity and mortality after releak are especially high, and complete healing of the leak may take time. Conclusions and Relevance Despite advances in medical management and surgical techniques, perforated PUD continues to have a relatively high rate of morbidity and mortality. Minimally invasive surgery is the current preferred treatment approach.
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Affiliation(s)
- Seyed A Arshad
- Division of Minimally Invasive and Gastrointestinal Surgery, Medical College of Wisconsin, Milwaukee
| | - Patrick Murphy
- Division of Trauma and Acute Care Surgery, Medical College of Wisconsin, Milwaukee
| | - Jon C Gould
- Division of Minimally Invasive and Gastrointestinal Surgery, Medical College of Wisconsin, Milwaukee
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Rasslan S, Coimbra R, Rasslan R, Utiyama EM. Management of perforated peptic ulcer: What you need to know. J Trauma Acute Care Surg 2025:01586154-990000000-00935. [PMID: 40090948 DOI: 10.1097/ta.0000000000004561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/19/2025]
Abstract
ABSTRACT Despite therapeutic advancements and the significant efficacy of medical management, peptic ulcer disease still affects millions of people. Elective surgical treatment, once a common intervention in General Surgery departments, is now nearly obsolete. Surgical treatment is reserved solely for complications, which occur in approximately 10% to 20% of cases. Perforation is the most common indication for surgery in peptic ulcer disease and accounts for nearly 40% of deaths from the disease. Treatment success depends on various factors, with early diagnosis and immediate surgical intervention being highlighted. Perforation is associated with a high incidence of morbidity and mortality. This article aims to analyze the different aspects related to the treatment of perforated peptic ulcers and define the best therapeutic approaches.
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Affiliation(s)
- Samir Rasslan
- From the Division of General Surgery and Trauma (S.R., R.R., E.M.U.), Faculdade de Medicina da Universidade de São Paulo, Brazil; Division of Acute Care Surgery and Comparative Effectiveness and Clinical Outcomes Research Center (CECORC) (R.C.), Riverside University Health System Medical Center, Moreno Valley; and Loma Linda University School of Medicine (R.C.), Loma Linda, California
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Trindade M, Gomes Pinto D, Carvalho N, Luz C. Role of Intraoperative Biopsy and Postoperative Upper Gastrointestinal Endoscopy in Patients Undergoing Surgery for Perforated Gastric Ulcer: A Retrospective Study. Cureus 2025; 17:e77092. [PMID: 39917103 PMCID: PMC11801807 DOI: 10.7759/cureus.77092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/06/2025] [Indexed: 02/09/2025] Open
Abstract
Introduction The intraoperative biopsy of a perforated gastric ulcer is a common practice; however, it may prove to be therapeutically futile, as an upper gastrointestinal endoscopy (UGE) is indicated regardless of the result. Objective To evaluate the histology of the perforated gastric ulcer biopsy (PGUB) and its effect on the subsequent clinical course. Methods A retrospective study (May 2017 to June 2024) of patients diagnosed with perforated gastric ulcer (K251 and K255 - ICD-10), with a review of medical records in the Medical Support System, was conducted. The histology of the PGUB, the performance of UGE, the degree of concordance between the histology of both, and the potential waiver of UGE were evaluated. Informed consent was waived, as this is an observational study without any interference with clinical conduct. Results During the evaluation period, 21 patients underwent PGUB, and 19 patients had a benign histological result; one patient was diagnosed with high-grade non-Hodgkin lymphoma, and one patient had gastric adenocarcinoma. In the following period, 10 patients underwent UGE, and in none of them did the histological diagnosis change. Of the remaining 11 patients who did not undergo UGE, five died, one was lost to follow-up, three are awaiting the procedure, and only two did not undergo the endoscopic exam. Conclusion The intraoperative biopsy of a perforated gastric ulcer is possibly futile, as it does not alter the clinical course. Regardless of the histological result obtained, a UGE is requested.
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Affiliation(s)
- Madalena Trindade
- Department of Surgery, Unidade Local de Saúde de Almada-Seixal, Almada, PRT
| | - Daniel Gomes Pinto
- Department of Pathology, Unidade Local de Saúde de Almada-Seixal, Almada, PRT
| | - Nuno Carvalho
- Department of Surgery, Unidade Local de Saúde de Almada-Seixal, Almada, PRT
| | - Carlos Luz
- Department of Surgery, Unidade Local de Saúde de Almada-Seixal, Almada, PRT
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Nageeb ME, Tobar W, Saqr A, Ragab AA, Elansary AMSEO. No drains versus drains after perforated peptic ulcer repair: A randomized controlled trail. Eur J Trauma Emerg Surg 2024; 50:2137-2145. [PMID: 38878063 DOI: 10.1007/s00068-024-02551-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Accepted: 05/09/2024] [Indexed: 11/27/2024]
Abstract
PURPOSE The study aimed to evaluate safety of omitting the intraabdominal drains after perforated peptic ulcer repairs. MATERIALS AND METHODS We conducted a prospective, randomized, controlled trial from January 2022 to January 2024 at the Emergency surgery department. Patients with perforated peptic ulcers were evaluated for eligibility. They were randomly assigned into two groups. In group A: two intraabdominal drains (pelvic and hepatorenal). in group B: no intraabdominal drains. The primary outcome was hospital length of stay (LOS), and the secondary outcomes included parameters of recovery and 30-day morbidities. The data were analyzed using SPSS 16 ®. RESULTS Thirty five patients were in the no drain group, while 36 patients were in the drain group. Patients in the no drains group had significantly earlier bowel motion (21.6 vs 28.69 hours; p = 0.004), fluid diet (73.54 vs 86.78 hours; p 0.001), and solid intake (84.4 vs. 98 hours; p 0.001), less pain severity (p = 0.0001) and shorter hospital stay (4.74 vs 5.75 days; p 0.001). A significant less morbidity, including surgical site infection (p = 0.01), and respiratory complications (p 0.0001), were in the no drain group. There was no difference of fever duration nor wound dehiscence. CONCLUSIONS Omitting the intraabdominal drains is safe after peptic ulcer perforation repair. It can improve outcomes. The study was registered at ClinicalTrials.gov Identifier: NCT06084741.
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Ogawa S, Endo H, Yoshida M, Tsuru T, Itabashi M, Yamamoto H, Kakeji Y, Ueno H, Kitagawa Y, Hibi T, Taketomi A, Ikeda N, Mori M. Effects of the COVID-19 pandemic on short-term postoperative outcomes of emergency surgery for gastroduodenal perforation: A nationwide study in Japan based on the National Clinical Database. Ann Gastroenterol Surg 2024; 8:795-806. [PMID: 39229559 PMCID: PMC11368502 DOI: 10.1002/ags3.12806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Revised: 03/26/2024] [Accepted: 04/04/2024] [Indexed: 09/05/2024] Open
Abstract
Aim To examine the potential negative effects of the COVID-19 pandemic on short-term postoperative outcomes of emergency surgery for gastroduodenal perforation in Japan. Methods A total of 7973 cases of gastroduodenal perforation from 2019 to 2021 were retrieved from the National Clinical Database (NCD), which includes >95% of surgical cases in Japan. Data were analyzed nationally and in subgroups for subjects in areas with high infection levels (HILs). Postoperative 30-d mortality, surgical mortality, and complications (Clavien-Dindo (CD) grade ≥3) were examined. Months were considered to have significantly high or low mortality or complication rates, if the 95% confidence interval (CI) of the standardized mortality (morbidity) ratio (SMR) does not contain 1. Results Nationally, data from 2019 vs 2020 and 2021 showed 30-d mortality of 175 (6.7%) vs 398 (7.4%), surgical mortality of 250 (9.5%) vs 537 (10.1%), and complications (CD ≥3) of 558 (21.2%) vs 1163 (21.8%). Among these data, the only significantly high SMR was found for complications in July 2020 (1.36 [95% CI: 1.001-1.80]). In areas with HILs, data from 2019 vs 2020 and 2021 indicated 30-d mortality of 91 (6.3%) vs 215 (7.3%), surgical mortality of 135 (9.4%) vs 294 (10.0%), and complications (CD ≥3) of 304 (21.1%) vs (23.1%). In these data, no month had a significantly high SMR. Conclusion The COVID-19 pandemic had few negative effects on outcomes after surgery for gastroduodenal perforation. These findings suggest that the emergency system for gastroduodenal perforation in Japan was generally maintained during the pandemic.
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Affiliation(s)
- Shimpei Ogawa
- The Japanese Society for Abdominal Emergency MedicineTokyoJapan
- Department of Surgery, Institute of GastroenterologyTokyo Women's Medical UniversityTokyoJapan
| | - Hideki Endo
- Department of Healthcare Quality Assessment, Graduate School of MedicineThe University of TokyoTokyoJapan
| | - Masahiro Yoshida
- The Japanese Society for Abdominal Emergency MedicineTokyoJapan
- Department of HBP and Gastrointestinal SurgeryInternational University of Health and WelfareIchikawaJapan
| | - Tomomitsu Tsuru
- The Japanese Society for Abdominal Emergency MedicineTokyoJapan
- Department of Medical Education and TrainingShin‐Koga HospitalKurumeFukuokaJapan
| | - Michio Itabashi
- The Japanese Society for Abdominal Emergency MedicineTokyoJapan
- Department of Surgery, Institute of GastroenterologyTokyo Women's Medical UniversityTokyoJapan
| | - Hiroyuki Yamamoto
- Department of Healthcare Quality Assessment, Graduate School of MedicineThe University of TokyoTokyoJapan
| | - Yoshihiro Kakeji
- Database CommitteeThe Japanese Society of Gastroenterological SurgeryTokyoJapan
- Division of Gastrointestinal Surgery, Department of SurgeryKobe University Graduate School of MedicineKobeHyogoJapan
| | - Hideki Ueno
- Database CommitteeThe Japanese Society of Gastroenterological SurgeryTokyoJapan
- Department of SurgeryNational Defense Medical CollegeTokorozawaSaitamaJapan
| | - Yuko Kitagawa
- The Japanese Society of Gastroenterological SurgeryTokyoJapan
- Department of SurgeryKeio University School of MedicineTokyoJapan
| | - Taizo Hibi
- The Japan Surgical SocietyTokyoJapan
- Department of Pediatric Surgery and TransplantationKumamoto University Graduate School of Medical SciencesKumamotoKumamotoJapan
| | - Akinobu Taketomi
- The Japan Surgical SocietyTokyoJapan
- Department of Gastroenterological Surgery IHokkaido University Graduate School of MedicineSapporoHokkaidoJapan
| | - Norihiko Ikeda
- The Japan Surgical SocietyTokyoJapan
- Department of SurgeryTokyo Medical UniversityTokyoJapan
| | - Masaki Mori
- The Japan Surgical SocietyTokyoJapan
- School of MedicineTokai UniversityIseharaKanagawaJapan
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Abouelazayem M, Jain R, Wilson MSJ, Martinino A, Balasubaramaniam V, Biffl W, Coccolini F, Riera M, Wadhawan H, Wazir I, Abderaouf B, Abramov D, Abu Jayyab MA, Al-Shami K, Alfarwan A, Alhajami FM, Alkaseek A, Alozairi O, Ammar AS, Atar B, Baatarjav GE, Bains L, Bakri A, Bayramov N, Bhojwani R, Brachini G, Calini G, Campanelli M, Cheng SY, Choudhary CS, Chowdhury S, Colak E, Das JK, Dawani S, Dönmez T, Elzayat I, Erdene S, Faizi TQ, Frountzas M, Gafsi B, Gentileschi P, Guler M, Gupta G, Harkati NE, Harris M, Hasan DM, Irowa OO, Jafferi S, Jain SA, Jun Han L, Kandiboyina SM, Karabulut M, Khamees A, Khan S, Khan MM, Khaw CJ, Kisielewski M, Klib M, Košir JA, Krawczyk WJ, Lisi G, Makama JG, Maqbool B, Marques CN, Meric S, Mietła MP, Ads AM, Muhumuza J, Mulita F, Mustafayeva M, Omar MA, Omarov T, Pathak AA, Paul R, Pavone G, Podda M, Raja Ram NK, Rauf F, Rauf S, Safy AM, Sandag E, Şanlı AN, Siddiqui AZ, Sotiropoulou M, Talib V, Tatar C, Thota A, Tokocin M, Tolat A, Uchikov PA, Valenzuela JI, Venkatappa SK, Verras GI, Vlahović I, Zreeg DAS, Cardoso VR, Gkoutos GV, Singhal R, Mahawar K. Global 30-day morbidity and mortality of surgery for perforated peptic ulcer: GRACE study. Surg Endosc 2024; 38:4402-4414. [PMID: 38886232 DOI: 10.1007/s00464-024-10881-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Accepted: 04/28/2024] [Indexed: 06/20/2024]
Abstract
BACKGROUND There is little international data on morbidity and mortality of surgery for perforated peptic ulcer (PPU). This study aimed to understand the global 30-day morbidity and mortality of patients undergoing surgery for PPU and to identify variables associated with these. METHOD We performed an international study of adults (≥ 18 years) who underwent surgery for PPU from 1st January 2022 to 30th June 2022. Patients who were treated conservatively or had an underlying gastric cancer were excluded. Patients were divided into subgroups according to age (≤ 50 and > 50 years) and time from onset of symptoms to hospital presentation (≤ 24 and > 24 h). Univariate and Multivariate analyses were carried out to identify factors associated with higher 30-day morbidity and mortality. RESULTS 1874 patients from 159 centres across 52 countries were included. 78.3% (n = 1467) of the patients were males and the median (IQR) age was 49 years (25). Thirty-day morbidity and mortality were 48.5% (n = 910) and 9.3% (n = 174) respectively. Median (IQR) hospital stay was 7 (5) days. Open surgery was performed in 80% (n = 1505) of the cohort. Age > 50 years [(OR = 1.7, 95% CI 1.4-2), (OR = 4.7, 95% CI 3.1-7.6)], female gender [(OR = 1.8, 95% CI 1.4-2.3), (OR = 1.9, 95% CI 1.3-2.9)], shock on admission [(OR = 2.1, 95% CI 1.7-2.7), (OR = 4.8, 95% CI 3.2-7.1)], and acute kidney injury [(OR = 2.5, 95% CI 1.9-3.2), (OR = 3.9), 95% CI 2.7-5.6)] were associated with both 30-day morbidity and mortality. Delayed presentation was associated with 30-day morbidity [OR = 1.3, 95% CI 1.1-1.6], but not mortality. CONCLUSIONS This study showed that surgery for PPU was associated with high 30-day morbidity and mortality rate. Age, female gender, and signs of shock at presentation were associated with both 30-day morbidity and mortality.
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Affiliation(s)
- Mohamed Abouelazayem
- Department of Surgery, University College London Hospitals, London, UK.
- Department of Surgery, National Cancer Institute, Cairo University, Cairo, Egypt.
- , General Surgery, University College Hospital, UCLH Contact Centre, Ground Floor North, 250 Euston Road, London, NW1 2PG, UK.
| | - Rajesh Jain
- Shrewsbury & Telford Hospital NHS Trust, Shrewsbury, UK
| | | | | | | | - Walter Biffl
- Trauma and Acute Care Surgery, Scripps Memorial Hospital, La Jolla, San Diego, CA, USA
| | - Federico Coccolini
- General, Emergency and Trauma Surgery Department, Pisa University Hospital, Pisa, Italy
| | | | - Himanshu Wadhawan
- Department of General Surgery, Forth Valley Royal Hospital, Larbert, UK
| | | | | | - Daniil Abramov
- Immanuel Kant Baltic Federal University, Kaliningrad, Russia
| | | | | | | | | | | | | | | | - Burak Atar
- Bakırköy Training and Research Hostpital, Bakirkoy, Turkey
| | | | | | | | | | | | - Gioia Brachini
- Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - Giacomo Calini
- Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Michela Campanelli
- San Carlo of Nancy Hospital, University of Rome Tor Vergata, Rome, Italy
| | | | | | | | | | | | | | - Turgut Dönmez
- Bakırköy Training and Research Hospital, Bakirkoy, Turkey
| | | | - Sarnai Erdene
- Mongolian National University of Medical Sciences, Ulaanbaatar, Mongolia
| | | | - Maximos Frountzas
- First Propaedeutic Department of Surgery, Hippocration General Hospital of Athens, Athens, Greece
| | - Besma Gafsi
- Fattouma Bourguiba University Hospital, Monastir, Tunisia
| | - Paolo Gentileschi
- San Carlo of Nancy Hospital, University of Rome Tor Vergata, Rome, Italy
| | - Mert Guler
- Istanbul Research and Training Hospital, Istanbul, Turkey
| | | | | | | | | | | | - Salman Jafferi
- Jinnah Postgraduate and Medical Center, Karachi, Pakistan
| | | | | | | | | | | | - Shahzeb Khan
- MTI Khyber Teaching Hospital, Peshawar, Pakistan
| | | | | | | | | | | | - Wiktor Jan Krawczyk
- Clinical Department of General, Colorectal and Trauma Surgery, Medical University of Silesia, Katowice, Poland
| | - Giorgio Lisi
- Department of Surgery, Sant'Eugenio Hospital, Viale Dell'Umanesimo 10, Rome, Italy
| | | | | | | | - Serhat Meric
- Bagcilar Training and Research Hospital, Istanbul, Turkey
| | - Mateusz Przemysław Mietła
- Clinical Department of General, Colorectal and Trauma Surgery, Medical University of Silesia, Katowice, Poland
| | | | | | | | - Matanat Mustafayeva
- Scientific Center of Surgery After Named M.A.Topchubashov, Azerbaijan, Azerbaijan
| | - Mohammed A Omar
- General Surgery Department, Qena Faculty of Medicine, South Valley University, Qena, Egypt
| | | | | | | | | | - Mauro Podda
- Department of Emergency Surgery, Cagliari University Hospital, Cagliari, Italy
| | | | - Fatima Rauf
- Benazir Bhutto Hospital, Rawalpindi, Pakistan
| | - Sidra Rauf
- Pakistan Institute of Medical Sciences, Islamabad, Pakistan
| | - Ahmed Mohamed Safy
- General Surgery Department, Qena Faculty of Medicine, South Valley University, Qena, Egypt
| | - Erdene Sandag
- Mongolian National University of Medical Sciences, Ulaanbaatar, Mongolia
| | | | | | | | - Vikash Talib
- Jinnah Postgraduate and Medical Center, Karachi, Pakistan
| | - Cihad Tatar
- Istanbul Research and Training Hospital, Istanbul, Turkey
| | - Anuroop Thota
- NRI Medical College, General & Superspeciality Hospital, Chinakakani, India
| | - Merve Tokocin
- Bagcilar Training and Research Hospital, Istanbul, Turkey
| | | | | | | | | | | | - Ivan Vlahović
- Department of Surgery, Clinical Hospital Center Osijek, University of Osijek, Osijek, Croatia
| | | | - Victor Roth Cardoso
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
- Centre for Health Data Science, University of Birmingham, Birmingham, UK
| | - Georgios V Gkoutos
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
- Centre for Health Data Science, University of Birmingham, Birmingham, UK
| | - Rishi Singhal
- University Hospital Birmingham NHS Foundation Trust, Birmingham, UK
| | - Kamal Mahawar
- South Tyneside and Sunderland NHS Foundation Trust, University of Sunderland, Sunderland, UK
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11
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Balaji L, Easwaran S, Subramaniam J. Salmonella Peritonitis Secondary to Gastroduodenal Perforation: An Unusual Presentation of Enteric Fever. Cureus 2024; 16:e65090. [PMID: 39171062 PMCID: PMC11338669 DOI: 10.7759/cureus.65090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2024] [Accepted: 07/21/2024] [Indexed: 08/23/2024] Open
Abstract
Salmonella-induced peritonitis, secondary to spontaneous gastrointestinal perforation, is a rare but potentially life-threatening condition. We present a case of a 62-year-old female with a history of systemic hypertension, who presented with diffuse abdominal pain and altered bowel habits. Initial evaluation suggested acute gastroenteritis, but worsening symptoms led to emergent exploratory laparotomy, revealing a gastric/duodenal perforation. Peritoneal fluid analysis and culture confirmed Salmonella Paratyphi A infection. The patient underwent an emergency laparotomy with omental patch repair and received intravenous ceftriaxone, leading to a full recovery. This case underscores the importance of considering Salmonella infection in the differential diagnosis of peritonitis, prompt surgical intervention, and appropriate antimicrobial therapy for optimal management and outcomes. Further research on epidemiological trends, host-pathogen interactions, and antibiotic resistance should be explored. Clinical studies should refine diagnostic criteria and treatment protocols, while animal models can aid in understanding pathophysiology and vaccine development for Salmonella peritonitis. Public health interventions and environmental studies will enhance prevention and control strategies.
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Affiliation(s)
- Lavanya Balaji
- Department of Microbiology, Saveetha Medical College and Hospitals, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai, IND
| | - Subbalakshmi Easwaran
- Department of Microbiology, Saveetha Medical College and Hospitals, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai, IND
| | - Jayakumar Subramaniam
- Department of Microbiology, Saveetha Medical College and Hospitals, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai, IND
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12
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Edyedu I, Okedi FX, Muhumuza J, Asiimwe D, Laker G, Lule H. Factors associated with peptic ulcer perforations in Uganda: a multi-hospital cross-sectional study. BMC Gastroenterol 2024; 24:199. [PMID: 38886654 PMCID: PMC11181620 DOI: 10.1186/s12876-024-03285-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Accepted: 06/07/2024] [Indexed: 06/20/2024] Open
Abstract
INTRODUCTION Perforated peptic ulcer is the worst complication of peptic ulcer disease whose burden is disproportionately higher in low-income settings. However, there is paucity of published data on the patterns of perforated peptic ulcer in the region. The aim of this study was to determine the factors associated with anatomical patterns of peptic ulcer perforation, as well as the clinical, socio-demographic, and anatomical patterns among patients in Uganda. METHODS This was a cross sectional study that enrolled 81 consecutive patients with perforated peptic ulcers. Using a structured pretested questionnaire the social demographic and clinical characteristics were obtained. At surgery, the patterns of the perforations were determined. Logistic regression was done in SPSS version 22 to determine the factors associated with the anatomical patterns. RESULTS Perforated peptic ulcer disease was more prevalent among males (79.5%), peasants (56.8%) and those from rural areas (65.4%). Majority of study participants were of blood group O (43.2%). Gastric perforations were more common (74.1%). Majority of the perforations were found anteriorly (81.5%). Being a casual laborer was independently associated with lower odds of having a gastric perforation compared to being a peasant farmer (P < 0.05). CONCLUSION Public health campaigns aimed at prevention of peptic ulcer perforations should prioritize the males, peasants and those living in rural areas. When a patient in our setting is suspected to have a peptic ulcer perforation, the anterior part of the stomach should be considered as the most likely site involved more so in peasant farmers.
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Affiliation(s)
- Isaac Edyedu
- Department of Surgery, Faculty of Clinical Medicine and Dentistry, Kampala International University Western Campus, PO. Box 70, Ishaka-Bushenyi, Uganda.
| | - Francis Xaviour Okedi
- Department of Surgery, Faculty of Clinical Medicine and Dentistry, Kampala International University Western Campus, PO. Box 70, Ishaka-Bushenyi, Uganda
| | - Joshua Muhumuza
- Department of Surgery, Faculty of Clinical Medicine and Dentistry, Kampala International University Western Campus, PO. Box 70, Ishaka-Bushenyi, Uganda.
| | - Daniel Asiimwe
- Department of Surgery, Faculty of Clinical Medicine and Dentistry, Kampala International University Western Campus, PO. Box 70, Ishaka-Bushenyi, Uganda
| | - Goretty Laker
- Faculty of Clinical Medicine and Dentistry, Department of pediatrics and child health, Kampala International University Western Campus, Ishaka-Bushenyi, Uganda
| | - Herman Lule
- Injury Epidemiology and Prevention Research Group, Division of Clinical Neuroscience, University of Turku, Turku, Finland
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13
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Harris A, Chance N, Fillerup I, Morrison E, Goethals A. Duodenal Ulceration Erosion Into the Common Bile Duct Status Post-Roux-en-Y Gastric Bypass: A Case Report. Cureus 2024; 16:e62496. [PMID: 39022460 PMCID: PMC11253586 DOI: 10.7759/cureus.62496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/16/2024] [Indexed: 07/20/2024] Open
Abstract
Peptic ulcer disease (PUD) affects approximately four million people worldwide. The most common etiologies of PUD are Helicobacter pylori (H. pylori) infections, chronic nonsteroidal anti-inflammatory drug (NSAID) use, and smoking. A rare cause of ulcer formation is documented in patients following Roux-en-Y gastric bypass (RYGB) procedures. Delayed treatment of these ulcers can further lead to ulcer perforation, erosion of the gastroduodenal artery (GDA), and fistula formation between the biliary structures and the gastrointestinal tract. Herein, we discuss the case of a 69-year-old female with an ulcer perforation 19 years after RYGB, resulting in an atypical ulcer erosion of the common bile duct without fistula formation.
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Affiliation(s)
- Andrew Harris
- Internal Medicine, Oklahoma State University Medical Center, Tulsa, USA
| | - Nathan Chance
- Obstetrics and Gynecology, McLaren Greater Lansing Hospital, Lansing, USA
| | - Ian Fillerup
- Internal Medicine, Baylor Scott & White Medical Center, Temple, USA
| | - Eric Morrison
- General Surgery, Ascension Genesys Hospital, Grand Blanc, USA
| | - Andrea Goethals
- General Surgery, Ascension Genesys Hospital, Grand Blanc, USA
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14
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Steyn PF, Karusseit O. Gastric perforation biopsy: is it obsolete? Langenbecks Arch Surg 2024; 409:139. [PMID: 38676744 PMCID: PMC11055769 DOI: 10.1007/s00423-024-03325-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Accepted: 04/15/2024] [Indexed: 04/29/2024]
Abstract
PURPOSE The aim of the study was to test the established hypothesis that biopsies of spontaneous gastric perforations should be taken to rule out cancer. METHODS A prospective observational study was performed. Consecutive patients with spontaneous gastric perforation were included. Biopsies of the edges of the perforation were submitted for histological evaluation. The epithelial type as well as the nature of the pathology were evaluated. RESULTS Sixty-eight patients were included. Eight (12%) biopsies revealed duodenal origin. Sixty (88%) biopsies revealed gastric mucosa of which 33 (48%) could be specifically typed. All biopsies revealed benign ulceration. No malignancies were detected in these biopsies or on subsequent gastroscopic follow up. CONCLUSION This study suggests that routine intraoperative biopsy of gastric perforation may be questioned. Biopsy is probably better performed endoscopically after recovery.
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Affiliation(s)
- Petre Francois Steyn
- Department of Surgery, University of Pretoria Medical School, Pretoria, South Africa
| | - Otto Karusseit
- Department of Surgery, University of Pretoria Medical School, Pretoria, South Africa.
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15
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Mishra P, Rehman N, Mitra S, Madakshira MG. Exsanguinated to death by a perforated duodenal ulcer: Masquerader apprehended on autopsy. INDIAN J PATHOL MICR 2024; 67:405-407. [PMID: 38391300 DOI: 10.4103/ijpm.ijpm_129_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Accepted: 03/10/2022] [Indexed: 02/24/2024] Open
Abstract
ABSTRACT Gastroduodenal perforation commonly due to spontaneous perforation of a pre-existing peptic ulcer is a surgical emergency. On laparotomy, approximately 60%-70% perforations are duodenal and 15%-20% gastric. The most prevalent etiology are Helicobacter pylori infection in 65%-70% and non-steroidal anti-inflammatory drugs (NSAIDS) abuse in 30%-50% cases depending on the prevalence of H. pylori infection. We report here the autopsy findings in a 29-year-old male who collapsed suddenly in the emergency room of our hospital after a bout of massive hematemesis.
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Affiliation(s)
- Priyanka Mishra
- Department of Pathology, Command Hospital, Lucknow, Uttar Pradesh, India
| | - Nidhin Rehman
- Department of Pathology, Command Hospital, Lucknow, Uttar Pradesh, India
| | | | - Manoj G Madakshira
- Department of Pathology, Command Hospital, Lucknow, Uttar Pradesh, India
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16
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Wadewitz E, Friedrichs J, Grilli M, Vey J, Zimmermann S, Kleeff J, Ronellenfitsch U, Klose J, Rebelo A. Approaches for the treatment of perforated peptic ulcers: a network meta-analysis of randomised controlled trials - study protocol. BMJ Open 2024; 14:e082732. [PMID: 38503410 PMCID: PMC10953088 DOI: 10.1136/bmjopen-2023-082732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2023] [Accepted: 03/01/2024] [Indexed: 03/21/2024] Open
Abstract
INTRODUCTION Perforated peptic ulcers are a life-threatening complication associated with high morbidity and mortality. Several treatment approaches are available. The aim of this network meta-analysis (NMA) is to compare surgical and alternative approaches for the treatment of perforated peptic ulcers regarding mortality and other patient-relevant outcomes. METHODS AND ANALYSIS A systematic literature search of PubMed/MEDLINE, Cochrane Library, Embase, CINAHL, ClinicalTrials.gov trial registry and ICTRP will be conducted with predefined search terms.To address the question of the most effective treatment approach, an NMA will be performed for each of the outcomes mentioned above. A closed network of interventions is expected. The standardised mean difference with its 95% CI will be used as the effect measure for the continuous outcomes, and the ORs with 95% CI will be calculated for the binary outcomes. ETHICS AND DISSEMINATION In accordance with the nature of the data used in this meta-analysis, which involves aggregate information from previously published studies ethical approval is deemed unnecessary. Results will be disseminated directly to decision-makers (eg, surgeons, gastroenterologists) through publication in peer-reviewed journals and presentation at conferences. PROSPERO REGISTRATION NUMBER CRD42023482932.
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Affiliation(s)
- Elisabeth Wadewitz
- University Hospital Halle (Saale), Germany, Department of Visceral, Vascular and Endocrine Surgery, Martin Luther University Halle Wittenberg, Halle, Germany
| | - Juliane Friedrichs
- Department of Visceral, Vascular and Endocrine Surgery, Martin Luther University of Halle Wittenberg Faculty of Medicine, Halle (Saale), Germany
| | - Maurizio Grilli
- Library of the Medical Faculty Mannheim, Heidelberg University, Mannheim, German, Heidelberg University Medical Faculty Mannheim, Mannheim, Germany
| | - Johannes Vey
- Institute of Medical Biometry, University Hospital Heidelberg, Heidelberg, Germany
| | - Samuel Zimmermann
- Institute of Medical Biometry, University Hospital Heidelberg, Heidelberg, Germany
| | - Joerg Kleeff
- University Hospital Halle (Saale), Germany, Department of Visceral, Vascular and Endocrine Surgery, Martin Luther University Halle Wittenberg, Halle, Germany
| | - Ulrich Ronellenfitsch
- Department of Visceral, Vascular and Endocrine Surgery, Martin Luther University Halle Wittenberg, Halle (Saale), Germany
| | - Johannes Klose
- University Hospital Halle (Saale), Germany, Department of Visceral, Vascular and Endocrine Surgery, Martin Luther University Halle Wittenberg, Halle, Germany
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17
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Zaman T, Haq A, Ahmad R, Sinha S, Chowdhury K, Parvin S, Imran M, Humayra ZU, Kumar S, Haque M. The Role of Probiotics in the Eradication of Helicobacter pylori and Overall Impact on Management of Peptic Ulcer: A Study Involving Patients Undergoing Triple Therapy in Bangladesh. Cureus 2024; 16:e56283. [PMID: 38495972 PMCID: PMC10944298 DOI: 10.7759/cureus.56283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/16/2024] [Indexed: 03/19/2024] Open
Abstract
Background Helicobacter pylori infection has been identified to cause constantly recurring inflammation, leading to gastrointestinal tract disorders, including carcinoma. The standard triple therapy (STT), used to eradicate H. pylori, includes two antimicrobials and a proton pump inhibitor for two weeks. Other drug regimens have also been developed since H. pylori exhibits antimicrobial resistance. These regimens, including probiotics, have been shown to lower adverse drug reactions (ADR), improve drug adherence, exert bacteriostatic effect, and reduce inflammation. Objective This study intended to explore probiotic intervention for improving eradication rates and mitigating adverse effects while administrating STT. Methods This prospective study was conducted from May to December, 2021, in the Department of Gastroenterology of Ship International Hospital, Dhaka, Bangladesh, to observe the effects of probiotics inclusion along with STT on H. pylori eradication. A total of 100 patients aged ≥18 years who tested positive for H. pylori were included. The experimental group (n=50) was given STT and probiotics, and the control group (n=50) was given only STT without probiotics for 14 days. Necessary follow-up was done six weeks after treatment. An independent sample t-test, chi-square test, and multiple regression analysis were used for statistical analysis. Result The odds of getting rapid urease test (RUT) negative results from positive were 2.06 times higher (95%CI= 0.95, 3.22, p=0.054) in the experimental group. ADRs were crucially towering in the control group (p=0.045) compared to the probiotics group. The probiotics group had a lower risk of having adverse effects by 0.54 times (95%CI=0.19, 0.84, p=0.032) than the control group. Conclusion Using probiotics and STT together to eradicate H. pylori may lower ADR and improve treatment adherence. It may also help terminate H. pylori infection more effectively. More research is required as H. pylori is very contagious and can ultimately cause life-threatening gastric cancer.
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Affiliation(s)
- Taslima Zaman
- Department of Gastroenterology, United Hospital Ltd, Dhaka, BGD
| | - Ahsanul Haq
- Department of Biostatistics, RNA Biotech Limited, Dhaka, BGD
| | - Rahnuma Ahmad
- Department of Physiology, Medical College for Women & Hospital, Dhaka, BGD
| | - Susmita Sinha
- Department of Physiology, Khulna City Medical College and Hospital, Khulna, BGD
| | - Kona Chowdhury
- Department of Pediatrics, Gonoshasthaya Samaj Vittik Medical College, Dhaka, BGD
| | - Sultana Parvin
- Department of Medical Gastroenterology, Sheikh Russel National Gastroliver Institute & Hospital, Dhaka, BGD
| | - Mostofa Imran
- Department of Gastroenterology, Ibn Sina Medical College & Hospital, Dhaka, BGD
| | - Zaman U Humayra
- Department of Plastic and Reconstructive Surgery, Ship International Hospital, Dhaka, BGD
| | - Santosh Kumar
- Department of Periodontology and Implantology, Karnavati School of Dentistry, Karnavati University, Gandhinagar, IND
| | - Mainul Haque
- Karnavati Scientific Research Center (KSRC), Karnavati School of Dentistry, Karnavati University, Gandhinagar, IND
- Unit of Pharmacology and Therapeutics, National Defence University of Malaysia, Kuala Lumpur, MYS
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18
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Seenarain V, Wilson T, Fletcher DR, Foster AJ. Retrospective comparison of outcomes of patients undergoing omental patch versus falciform patch repair of perforated peptic ulcers. ANZ J Surg 2024; 94:371-374. [PMID: 37828782 DOI: 10.1111/ans.18728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 09/21/2023] [Accepted: 09/26/2023] [Indexed: 10/14/2023]
Abstract
BACKGROUND The omental patch repair is the gold standard for the repair of perforated peptic ulcers. This can be performed open or laparoscopically. However, in the event of non-viable or inadequate omentum available at the time of surgery the falciform ligament has been reportedly used to as an alternative. Nonetheless, evidence for its safety is scant. This study aims to determine differences in patient outcomes when comparing the two repair techniques. METHODS Following ethics approval, patients who underwent surgical repair of perforated peptic ulcers using omental or falciform patch repair, between 1 January 2010 and 31 December 2017, across all three Western Australian tertiary hospital services and at least 18 years of age were included. Data were collected by reviewing medical records of included patients. RESULTS Three hundred twenty-nine patients who underwent either open or laparoscopic repairs were included. Thirty-seven patients had falciform repairs and were mostly ASA of 2 compared to 292 patients receiving omental patch repair who were mostly ASA 3. Falciform patch repairs were more commonly used in duodenal ulcer perforations. There were no statistically significant differences in patient outcomes between the omental patch and falciform ligament groups. This included post-operative intra-abdominal sepsis, return to theatre, post-operative ICU admission, inpatient mortality, 30-day readmission and ulcer healing on follow-up gastroscopy. CONCLUSIONS This study demonstrates safety, efficacy and similar outcomes for patients receiving the falciform ligament patch repair compared with omental patch repair.
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Affiliation(s)
- Vidya Seenarain
- Division of Surgery, Medical School, University of Western Australia, Murdoch, Western Australia, Australia
- Department of General Surgery, Fiona Stanley Hospital, Murdoch, Western Australia, Australia
| | - Tamalee Wilson
- Department of General Surgery, Fiona Stanley Hospital, Murdoch, Western Australia, Australia
| | - David R Fletcher
- Division of Surgery, Medical School, University of Western Australia, Murdoch, Western Australia, Australia
- Department of General Surgery, Fiona Stanley Hospital, Murdoch, Western Australia, Australia
| | - Amanda J Foster
- Division of Surgery, Medical School, University of Western Australia, Murdoch, Western Australia, Australia
- Department of General Surgery, Fiona Stanley Hospital, Murdoch, Western Australia, Australia
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19
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Amalia R, Vidyani A, I’tishom R, Efendi WI, Danardono E, Wibowo BP, Parewangi ML, Miftahussurur M, Malaty HM. The Prevalence, Etiology and Treatment of Gastroduodenal Ulcers and Perforation: A Systematic Review. J Clin Med 2024; 13:1063. [PMID: 38398375 PMCID: PMC10888557 DOI: 10.3390/jcm13041063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Revised: 01/31/2024] [Accepted: 02/09/2024] [Indexed: 02/25/2024] Open
Abstract
(1) Background: Gastroduodenal perforation (GDP) is a life-threatening condition caused by a spontaneous or traumatic event. Treatment should be based on the mechanism of damage, timing, location, extent of the injury, and the patient's clinical condition. We aimed to examine several etiologic factors associated with gastroduodenal perforation and to search for the best method(s) for its prevention and treatment. (2) Methods: We conducted extensive literature reviews by searching numerous studies obtained from PubMed, Science Direct, and Cochrane for the following keywords: gastroduodenal perforation, Helicobacter pylori, NSAIDs' use, side effects of GDP, laparoscopy, and surgery. The primary outcome was the reported occurrence of GDP. (3) Results: Using keywords, 883 articles were identified. After applying the inclusion and exclusion criteria, 53 studies were eligible for the current analyses, with a total number of 34,692 gastroduodenal perforation cases. Even though the risk factors of gastroduodenal perforation are various, the prevalence of H. pylori among patients with perforation is considerably high. As technology develops, the treatment for gastric perforation will also improve, with laparoscopic surgery having a lower mortality and complication rate compared to open surgery for GDP treatment. (4) Conclusions: H. pylori infection plays the most significant role in GDP, more than NSAIDs, surgery, chemotherapy, or transplantation. Treatment of H. pylori infection is essential to decrease the prevalence of GDP and speed up its recovery. However, urgent cases require immediate intervention, such as laparoscopic or open surgery.
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Affiliation(s)
- Rizki Amalia
- Department of Environmental and Preventive Medicine, Oita University Faculty of Medicine, Yufu 879-5593, Japan;
- Helicobacter pylori and Microbiota Study Group, Institute of Tropical Disease, Universitas Airlangga, Surabaya 60286, Indonesia;
| | - Amie Vidyani
- Division of Gastroentero-Hepatology, Department of Internal Medicine, Faculty of Medicine-Dr. Soetomo Teaching Hospital, Universitas Airlangga, Surabaya 60115, Indonesia
| | - Reny I’tishom
- Department of Medical Biology, Faculty of Medicine, Universitas Airlangga, Surabaya 60132, Indonesia;
| | - Wiwin Is Efendi
- Department of Pulmonology and Respiratory Medicine, Faculty of Medicine, Universitas Airlangga, Surabaya 60132, Indonesia;
| | - Edwin Danardono
- Department of Surgery, Faculty of Medicine, Universitas Airlangga, Surabaya 60132, Indonesia;
| | - Bogi Pratomo Wibowo
- Department of Endocrinology, Saiful Anwar General Hospital, Malang 65111, Indonesia;
| | - Muhammad Lutfi Parewangi
- Division of Gastroenterology-Hepatology, Department of Internal Medicine, Faculty of Medicine, Hasanuddin University, Makassar 90245, Indonesia;
| | - Muhammad Miftahussurur
- Helicobacter pylori and Microbiota Study Group, Institute of Tropical Disease, Universitas Airlangga, Surabaya 60286, Indonesia;
- Division of Gastroentero-Hepatology, Department of Internal Medicine, Faculty of Medicine-Dr. Soetomo Teaching Hospital, Universitas Airlangga, Surabaya 60115, Indonesia
| | - Hoda M. Malaty
- Division of Gastroentero-Hepatology, Department of Internal Medicine, Faculty of Medicine-Dr. Soetomo Teaching Hospital, Universitas Airlangga, Surabaya 60115, Indonesia
- Department of Medicine, Baylor College of Medicine, Houston, TX 77030, USA
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20
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Wang K, Thida A, Seong G, Chiu E. Perforated Gastric Cancer: A Case Report and Literature Review. Cureus 2024; 16:e51767. [PMID: 38322053 PMCID: PMC10844135 DOI: 10.7759/cureus.51767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/04/2024] [Indexed: 02/08/2024] Open
Abstract
Gastric cancer perforation is a rare but life-threatening complication of gastric cancer. We present the case of a 53-year-old male with acquired immune deficiency syndrome (AIDS) who presented to the emergency department with severe abdominal pain, was found to have an acute abdomen, and was eventually diagnosed with gastric perforation due to metastatic gastric cancer. This case highlights the challenges in diagnosing and managing perforated gastric cancer and discusses the surgical management options, including the use of laparoscopic techniques and the role of chemotherapy, particularly hyperthermic intraperitoneal chemotherapy (HIPEC).
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Affiliation(s)
- Kai Wang
- Department of Internal Medicine, St. George's University School of Medicine, New York, USA
| | - Aye Thida
- Department of Hematology and Oncology, SUNY (State University of New York) Downstate Health Sciences University/Kings County Hospital Center, New York, USA
| | - Gyuhee Seong
- Department of Medicine, SUNY (State University of New York) Downstate Health Sciences University/Kings County Hospital Center, New York, USA
| | - Edwin Chiu
- Department of Hematology and Oncology, SUNY (State University of New York) Downstate Health Sciences University/Kings County Hospital Center, New York, USA
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Li ZW, Tong Y, Liu F, Liu XR, Lv Q, Tang KL, Li LS, Liu XY, Zhang W, Peng D. A comparative study on laparoscopic and open surgical approaches for perforated peptic ulcer repair: efficacy and outcomes analysis. Langenbecks Arch Surg 2023; 408:435. [PMID: 37964034 DOI: 10.1007/s00423-023-03171-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 10/30/2023] [Indexed: 11/16/2023]
Abstract
PURPOSE This study aimed to compare the clinical outcomes of the clinical outcomes of laparoscopic and open sutures for peptic ulcer perforation (PPU). MATERIALS AND METHODS PubMed, EMBASE, and Cochrane Library databases were searched for eligible studies from inception to March 31, 2023. Odds ratios (OR) and 95% confidence intervals (Cl) were also calculated. The Newcastle-Ottawa Scale (NOS) was used to evaluate the quality of the included studies. This study was performed using the Stata (V.16.0) software. RESULTS A total of 29 studies involving 17,228 patients were included in this study. In terms of postoperative outcomes, the laparoscopic group had a shorter postoperative hospital stay (MD = -0.29, 95%CI = -0.44 to -0.13, P = 0.00), less blood loss (MD = -0.45, 95%CI = -0.82 to -0.08, P = 0.02), fewer wound infection (OR = 0.20, 95%CI = 0.17 to 0.24, P = 0.00), fewer pneumonia (OR = 0.59, 95%CI = 0.41 to 0.87, P = 0.01), fewer respiratory complications (OR = 0.26, 95%CI = 0.13 to 0.55, P = 0.00) and lower postoperative morbidity (OR = 0.51, 95%CI = 0.33 to 0.78, P = 0.00). The laparoscopic group had a lower mortality rate (OR = 0.36, 95%CI = 0.27 to 0.49, P = 0.00) than the open group. We also found that the laparoscopic group had a higher overall complication rate than the open group (OR = 0.45, 95%CI = 0.34 to 0.60, P = 0.00). CONCLUSION Laparoscopic repair was associated with a lower risk of mortality than open repair in patients with PPU. Laparoscopic repair may be a better option in patients with PPU.
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Affiliation(s)
- Zi-Wei Li
- Department of Gastrointestinal Surgery, the First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Yue Tong
- Department of Gastrointestinal Surgery, the First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Fei Liu
- Department of Gastrointestinal Surgery, the First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Xu-Rui Liu
- Department of Gastrointestinal Surgery, the First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Quan Lv
- Department of Gastrointestinal Surgery, the First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Kai-Lin Tang
- Department of Gastrointestinal Surgery, the First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Lian-Shuo Li
- Department of Gastrointestinal Surgery, the First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Xiao-Yu Liu
- Department of Gastrointestinal Surgery, the First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Wei Zhang
- Department of Gastrointestinal Surgery, the First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Dong Peng
- Department of Gastrointestinal Surgery, the First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China.
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Nanack JJ, Ferndale L. Factors influencing outcome in patients with perforated peptic ulcer disease at a South African tertiary hospital. S AFR J SURG 2023; 61:207-211. [PMID: 38450692 DOI: 10.36303/sajs.4005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2023]
Abstract
BACKGROUND Perforated peptic ulcer (PPU) is associated with significant morbidity and mortality, particularly in low to middle income countries. This study aimed to scrutinise the clinical course of patients diagnosed with PPU and identify modifiable factors to improve outcomes. METHODS A retrospective review of the hybrid electronic medical record (HEMR) database at Grey's Hospital was performed. All patients diagnosed with PPU between January 2013 and December 2020 were entered into the study. The variables collected include age, ethnicity, comorbid profile, Boey score, type of surgery performed and complications. These factors were analysed to determine the factors responsible for morbidity and mortality. RESULTS One hundred and ninety four patients were diagnosed with PPU during the study period. Six patients were treated non-operatively, all of whom survived. In the surgically treated group, omental patch repair was performed in 159 (84.5%) patients, and primary closure in 26 (13.8%) patients. The leak rate was 32% in the cohort that underwent relaparotomy and the overall mortality was 14%. There was no significant relationship between the type of repair performed and outcome. All patients had a Boey score of 1 or more. The following factors were found to increase the probability of in-hospital mortality: age > 40 years (OR: 8.49, 95% CI 2.46-29.29 p < 0.01), female gender (OR: 2.509, CI 0.98-6.37, p = 0.048), need for relaparotomy (OR: 0.398, CI 0.17-0.91, p = 0.027) and Boey score > 1 (OR: 46.437, CI 6.13-350.28, p < 0.01). A Boey score > 1 was the only variable that increased the likelihood of finding a leaking repair at relaparotomy (p < 0.01). CONCLUSION The Boey score was a significant predictor of mortality and leak rate in our patients with PPU. Adding age as a variable may improve the ability to predict mortality in our setting, while the impact of gender and ethnicity needs further investigation.
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Affiliation(s)
- J J Nanack
- Department of General Surgery, University of KwaZulu-Natal, South Africa
| | - L Ferndale
- Department of Gastro-Intestinal Surgery, Grey's Hospital, South Africa
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Yuan W, Zhou X, Cai Z, Qiu J, Li X, Tong G. Risk Factors of Gastrointestinal Perforation with a Poor Prognosis. Int J Gen Med 2023; 16:4637-4647. [PMID: 37868819 PMCID: PMC10588753 DOI: 10.2147/ijgm.s426676] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Accepted: 10/09/2023] [Indexed: 10/24/2023] Open
Abstract
Background Despite medical progress, mortality from gastrointestinal perforation was relatively high. Our study's objective was to identify risk factors associated with a poor prognosis for gastrointestinal perforation. Methods Patients diagnosed with gastrointestinal perforation at the Longchuan County People's Hospital between January 2019 and February 2022 were the subject of a retrospective analysis of their laboratory data. Patients were grouped based on length of hospital stay, septic shock, and mortality. Results A total of 240 patients participated in our study. Using univariate and multivariate analysis, we identified several risk factors for gastrointestinal perforation associated with a dismal prognosis. Lower digestive tract perforation (OR=2.418, 95% CI 1.119-5.227, P=0.025), low total protein (OR=0.934, 95% CI 0.879-0.992, P=0.026) and low hemoglobin (OR=0.985, 95% CI 0.971-0.999, P=0.039) were linked to a longer length of stay, especially hemoglobin (OR=0.978, 95% CI 0.966-0.991, P=0.001) in upper digestive tract. High ratio of neutrophils to lymphocytes (NLR) (OR=1.043, 95% CI 1.012-1.076, P=0.007), high lymphocyte-to-monocyte ratio (LMR) (OR=2.158, 95% CI 1.495-3.115, P<0.001) and low prognostic nutrition index (PNI) (OR=0.814, 95% CI 0.751-0.833, P<0.001) predicted septic shock. In upper digestive tract, PLR (OR=1.001, 95% CI 1.000-1.002, P=0.067), LMR (OR=2.160, 95% CI 1.440-3.240, P<0.001) and PNI (OR=0.843, 95% CI 0.767-0.926, P<0.001) were risk factors for septic shock, and total protein (OR=0.796, 95% CI 0.686-0.923, P=0.003) was a risk factor for septic shock in lower digestive tract. High NLR (OR=1.056, 95% CI 1.019-1.093, P=0.003), high LMR (OR=1.760, 95% CI 1.177-2.632, P=0.006) and low PNI (OR=0.832, 95% CI 0.754-0.918, P<0.001) were the risk factors of mortality. In subgroup analysis of perforation site, albumin (OR=0.820, 95% CI 0.719-0.934, P=0.003) and LMR (OR=1.506, 95% CI 1.069-2.123, P=0.019) were risk factors for mortality in upper digestive tract and PNI (OR=0.636, 95% CI 0.445-0.908, P=0.013) was a risk factor for mortality in lower digestive tract. Conclusion Our research found that the perforation site, total protein, albumin, hemoglobin, NLR, LMR, PLR and PNI were risk factors for gastrointestinal perforation with a poor prognosis.
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Affiliation(s)
- Wenqing Yuan
- Department of Gastrointestinal Surgery, Longchuan County People’s Hospital, Heyuan, 517300, People’s Republic of China
| | - Xiaozhuan Zhou
- Department of Gastroenterology, Peking University Shenzhen Hospital, Shenzhen, 518036, People’s Republic of China
| | - Zhigao Cai
- Department of Gastrointestinal Surgery, Longchuan County People’s Hospital, Heyuan, 517300, People’s Republic of China
| | - Junyu Qiu
- Department of Gastrointestinal Surgery, Longchuan County People’s Hospital, Heyuan, 517300, People’s Republic of China
| | - Xi Li
- Department of Gastroenterology, Peking University Shenzhen Hospital, Shenzhen, 518036, People’s Republic of China
| | - Gangling Tong
- Department of Gastrointestinal Surgery, Longchuan County People’s Hospital, Heyuan, 517300, People’s Republic of China
- Department of Oncology, Peking University Shenzhen Hospital, Shenzhen 518036, China and Shenzhen Key Laboratory of Gastrointestinal Cancer Translational Research, Cancer Institute of Shenzhen-PKU-HKUST Medical Center, Shenzhen, 518036, People’s Republic of China
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24
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Abdel Aziz M, Shetiwy M, Ezzat Elghrieb A, Saad Shetiwy M. Evaluación de factores de riesgo de fuga después de la reparación de una úlcera péptica perforada con parche de epiplón. Estudio retrospectivo. REVISTA COLOMBIANA DE CIRUGÍA 2023. [DOI: 10.30944/20117582.2420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2025] Open
Abstract
Introducción. La úlcera péptica perforada es una de las afecciones abdominales críticas que requiere una intervención quirúrgica temprana. La fuga después de la reparación con parche de epiplón representa una de las complicaciones más devastadoras, que aumentan la morbilidad y la mortalidad. Nuestro estudio tuvo como objetivo evaluar los factores de riesgo y los predictores tempranos de fugas.
Métodos. Análisis retrospectivo de los datos de los pacientes sometidos a reparación con parche de epiplón por úlcera péptica perforada, en el período comprendido entre enero de 2019 y enero de 2022, en el Hospital Universitario de Mansoura, Egipto. Se recogieron y analizaron estadísticamente variables pre, intra y postoperatorias. Los factores de riesgo asociados a la incidencia de fugas se analizaron mediante análisis univariado y multivariado.
Resultados. Este estudio incluyó 123 pacientes que cumplieron con los criterios de inclusión. Se detectó fuga en siete (5,7 %) pacientes. Aunque las comorbilidades asociadas (p=0,01), el ingreso postoperatorio a la unidad de cuidados intensivos (p=0,03) y la hipotensión postoperatoria (p=0,02) fueron factores de riesgo en el análisis univariado, el shock séptico (p=0,001), el retraso en la intervención (p=0,04), la hipoalbuminemia preoperatoria (p=0,017) y el tamaño de la perforación mayor de 5 mm (p=0,04) se encontraron como factores de riesgo de fuga independientes en el análisis multivariado.
Conclusión. Se detectaron como factores de riesgo independientes de fuga la presentación tardía en shock séptico, la hipoalbuminemia preoperatoria, la perforación prolongada, el intervalo operatorio y el tamaño de la perforación mayor de 5 mm. La taquipnea posoperatoria y la taquicardia con niveles elevados de proteína C reactiva y recuento leucocitario total son signos de alarma sobre la presencia de fuga.
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25
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Chou TC, Lee CH, Soong RS, Chen YC. A simple and effective technique for laparoscopic gastrorrhaphy: modified Graham's patch with barbed suture. BMC Surg 2023; 23:295. [PMID: 37759211 PMCID: PMC10537802 DOI: 10.1186/s12893-023-02192-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 09/10/2023] [Indexed: 09/29/2023] Open
Abstract
INTRODUCTION Peptic ulcers are caused by unbalanced acid production, and proton pump inhibitors (PPIs) in recent decades have helped to treat peptic ulcers effectively. Meanwhile, the incidence of perforated peptic ulcer (PPU) persists and has a high mortality rate if there is no adequate management. Primary closure with a modified Graham's patch was well performed in early detected PPU with a small size < 2 cm. A laparoscopic approach for PPU was prescribed for decades with proven feasibility and safety. We introduced an effective technique combined with barbed suture and modified Graham's patch, which can significantly reduce the surgical time without significantly increasing morbidity and mortality compared with traditional interrupted suture. PATIENTS AND METHOD We retrospectively collected data from January 2014 to December 2020 in Keelung Change Gung Memorial Hospital, and a total of 154 patients receiving laparoscopic repair of PPU were included. There were 59 patients in the V-loc group (V group) and 95 patients in the laparoscopic primary repair group (P group). RESULTS The V group had a significantly shorter operation time than the P group (96.93 ± 22.14 min vs. 123.97 ± 42.14, P < 0.001). Ten patients suffered from morbidity greater than the Clavien‒Dindo classification 4 (5 from V group, and 5 from P group). Three patients with leakage were reported. Two patients were in the V group, and one patient was in the P group (p = 0.432). CONCLUSION Laparoscopic repair with barbed suture and modified Graham's patch provides a simple and effective technique in the management of acute abdomen. This technique can be easily performed by experienced surgeons and trainees in minimally invasive surgery without affecting patient safety.
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Affiliation(s)
- Ta-Chun Chou
- Department of Surgery, Keelung Branch, Chang Gung Memorial Hospital, No. 222, Maijin Rd., Anle Dist, 204201, Keelung City, Taiwan
| | - Chun-Hui Lee
- Department of Surgery, Keelung Branch, Chang Gung Memorial Hospital, No. 222, Maijin Rd., Anle Dist, 204201, Keelung City, Taiwan
| | - Ruey-Shyang Soong
- Division of Transplantation, Department of Surgery, Taipei Municipal Wan-Fang Hospital, Taipei Medical University, Taipei, Taiwan
- College of Medicine, Medical University, Taipei, Taiwan
| | - Yi-Chan Chen
- Department of Surgery, Keelung Branch, Chang Gung Memorial Hospital, No. 222, Maijin Rd., Anle Dist, 204201, Keelung City, Taiwan.
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Tandup C, Chauhan A, Chauhan R, Thakur V, Sahu S, Kaman L, Khare S, Sakaray Y, Nenavath KN, Kurdia KC. Impact of Tailored-Enhanced Recovery After Surgery Versus Conventional Care in Patients of Gastro-Duodenal Perforation: A Pilot Randomized Control Trial. Cureus 2023; 15:e45349. [PMID: 37849602 PMCID: PMC10578038 DOI: 10.7759/cureus.45349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/16/2023] [Indexed: 10/19/2023] Open
Abstract
BACKGROUND The enhanced recovery after surgery (ERAS) program established improved clinical outcomes in elective surgery; however, its role in emergencies is uncertain. This study was designed to assess the feasibility, safety, and efficacy of a tailored-ERAS (t-ERAS) protocol in patients undergoing modified Graham's patch closure for gastro-duodenal perforation. METHODS A single-centre, prospective, parallel-arm, open-label, randomized controlled trial was conducted from February 2021 to December 2021. Patients with gastroduodenal perforation undergoing modified Graham's patch were randomly assigned to either conventional care or the t-ERAS pathway. Patients with refractory septic shock, psychiatric or neurological disorders, pregnancy, multiple perforations, sealed-off perforations, and perforation sizes greater than 1.5 cm were excluded. The primary outcome was to compare the length of hospitalization (LOH). Functional recovery parameters and morbidity were compared in secondary outcomes. RESULTS Twenty-five patients each were included in conventional care and the t-ERAS group. In the t-ERAS group, LOH was significantly shorter (6.3 SD2.15 days versus 9.56 SD4.33 days, p = 0.001). Patients in the t-ERAS group had significantly early functional recovery (days) with time to first bowel sound (1.8 SD0.41; p 0.002), first flatus (2.52 SD0.65; p = 0.026), first stool (3.04 SD0.68; p < 0.001), first liquid diet (2.24 SD0.60; p = 0.002), and duration of ileus (2.64 SD0.86; p = 0.038). There was no significant difference in morbidity such as post-operative nausea and vomiting, SSI, or pulmonary complications between the two groups. CONCLUSION Tailored ERAS pathways are safe and effective in reducing the LOH and promoting early functional recovery in patients undergoing emergency closure of gastro-duodenal perforation.
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Affiliation(s)
- Cherring Tandup
- General Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, Chandigarh, IND
| | - Abhinav Chauhan
- General Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, Chandigarh, IND
| | - Rajeev Chauhan
- Anaesthesia and Intensive Care, Postgraduate Institute of Medical Education and Research, Chandigarh, Chandigarh, IND
| | - Vipul Thakur
- General Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, Chandigarh, IND
| | - Swapnesh Sahu
- General Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, Chandigarh, IND
| | - Lileswar Kaman
- General Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, Chandigarh, IND
| | - Siddhant Khare
- General Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, Chandigarh, IND
| | - Yashwant Sakaray
- General Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, Chandigarh, IND
| | - Krishna N Nenavath
- General Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, Chandigarh, IND
| | - Kailash C Kurdia
- General Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, Chandigarh, IND
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Singla A, Singh S, Kaur G, Jindal D, Singh N, Langstang S. Posterior Gastric Perforation with an Opening in Transverse Mesocolon: A Rare Case Report. Int J Appl Basic Med Res 2023; 13:189-191. [PMID: 38023602 PMCID: PMC10666828 DOI: 10.4103/ijabmr.ijabmr_92_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 06/03/2023] [Accepted: 06/22/2023] [Indexed: 12/01/2023] Open
Abstract
Posterior gastric perforation is a very rare finding, difficult to diagnose due to the insidious onset of upper abdominal symptoms, and no air under the diaphragm on X-ray. Posterior gastric perforation which opens into transverse mesocolon is even rarer. This is a case report done to entail such a rare case, with only two cases reported in the past. We present the case of a 21-year-old female with pain in the epigastric region spreading to involve the whole abdomen, fever, vomiting, and anorexia. In our case, radiological findings revealed pneumoperitoneum. Intraoperatively, a tract was identified between the posterior wall of the stomach and transverse mesocolon. Tract was excised and primary repair was done using the Graham patch method.
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Affiliation(s)
- Anand Singla
- Department of General Surgery, GMC and Rajindra Hospital, Patiala, Punjab, India
| | - Sandeep Singh
- Department of General Surgery, GMC and Rajindra Hospital, Patiala, Punjab, India
| | - Gagandeep Kaur
- Department of General Surgery, GMC and Rajindra Hospital, Patiala, Punjab, India
| | - Deepak Jindal
- Department of General Surgery, GMC and Rajindra Hospital, Patiala, Punjab, India
| | - Navjot Singh
- Department of General Surgery, GMC and Rajindra Hospital, Patiala, Punjab, India
| | - Sakini Langstang
- Department of General Surgery, GMC and Rajindra Hospital, Patiala, Punjab, India
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28
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Shekar N, Debata PK, Debata I, Nair P, Rao LS, Shekar P. Use of POSSUM (Physiologic and Operative Severity Score for the Study of Mortality and Morbidity) and Portsmouth-POSSUM for Surgical Assessment in Patients Undergoing Emergency Abdominal Surgeries. Cureus 2023; 15:e40850. [PMID: 37489217 PMCID: PMC10363332 DOI: 10.7759/cureus.40850] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/23/2023] [Indexed: 07/26/2023] Open
Abstract
INTRODUCTION The POSSUM (Physiologic and Operative Severity Score for the Study of Mortality and Morbidity) and Portsmouth-POSSUM (P-POSSUM) models have been popularly recommended as appropriate for predicting postoperative mortality and morbidity in surgical practice. This study aims to evaluate the efficacy and accuracy of both scoring systems for surgical risk assessment in predicting postoperative mortality and morbidity in patients undergoing emergency abdominal surgeries. METHODOLOGY The study was conducted as a part of a post-doctoral fellowship program. A total of 150 patients, undergoing emergency abdominal surgery in a tertiary care hospital in Bhubaneswar, were evaluated using POSSUM and P-POSSUM. Physiological scoring was done prior to surgery and operative scoring was performed intra-operatively. Patients were followed up for 30 days after the operative period. The observed mortality rate was then compared with POSSUM and P-POSSUM predicted mortality rates. RESULTS POSSUM predicted a morbidity rate of 116, whereas the actual morbidity rate was 92 (p < 0.05). P-POSSUM predicted a morbidity rate of 109, whereas the actual morbidity rate was 92 (p < 0.05). POSSUM predicted a mortality rate of 23, whereas the actual mortality rate was 21 (p < 0.05). P-POSSUM predicted a mortality rate of 25, whereas the actual mortality rate was 21 (p < 0.05). CONCLUSIONS With a reasonably good prediction of morbidity and mortality rate, POSSUM and P-POSSUM scores are both effective scoring systems in clinical practice for use in abdominal surgery.
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Affiliation(s)
- Nithya Shekar
- General Surgery, Vydehi Institute of Medical Sciences and Research Centre, Bengaluru, IND
| | - P K Debata
- General Surgery, Kalinga Institute of Medical Sciences, Bhubaneswar, IND
| | - Ipsita Debata
- Community and Family Medicine, Kalinga Institute of Medical Sciences, Bhubaneswar, IND
| | - Pallavi Nair
- General Surgery, Kalinga Institute of Medical Sciences, Bhubaneswar, IND
| | - Lakshmi S Rao
- General Surgery, Kalinga Institute of Medical Sciences, Bhubaneswar, IND
| | - Prithvi Shekar
- General Surgery, Vydehi Institute of Medical Sciences and Research Center, Bengaluru, IND
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Sivananthan A, Kerry G, Darzi A, Patel K, Patel N. Orientation in upper gastrointestinal endoscopy—the only way is up. World J Gastrointest Endosc 2023; 15:146-152. [PMID: 37034971 PMCID: PMC10080556 DOI: 10.4253/wjge.v15.i3.146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 01/15/2023] [Accepted: 02/21/2023] [Indexed: 03/16/2023] Open
Abstract
BACKGROUND Oesophagogastroduodenoscopy is the gold standard investigation for the upper gastrointestinal (UGI) tract. Orientation during endoscopy is challenging and United Kingdom training focusses on technical competence and procedural safety. The reported location of UGI pathologies is crucial to post-endoscopic planning.
AIM To evaluate endoscopists’ ability to spatially orientate themselves within the UGI tract.
METHODS A cross sectional descriptive study elicited, using an anonymised survey, the ability of endoscopists to orientate themselves within the UGI tract. The primary outcome was percentage of correct answers from all surveyed; secondary outcomes were percentage of correct answers from experienced vs novice endoscopists. Pearson’s χ2 test was applied to compare groups.
RESULTS Of 188 respondents, 86 were experienced endoscopists having completed over 1000 endoscopies. 44.4% of respondents correctly identified the anterior stomach and 47.3% correctly identified the posterior of the second part of the duodenum (D2). Experienced endoscopists were significantly more likely than novice to identify the anterior stomach correctly [61.6% vs 31.3%, X2 (1, n = 188) = 11.10, P = 0.001]. There was no significant difference between the two groups in identifying the posterior of D2.
CONCLUSION The majority of endoscopists surveyed were unable to identify key landmarks within the UGI tract. Endoscopic orientation appears to improve with experience yet there are some areas still not well recognised. This has potential considerable impact on post-endoscopic management of patients with posterior duodenal ulcers being more likely to perforate and associated with a higher rebleeding risk. We suggest the development of a consensus statement on endoscopic description.
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Affiliation(s)
- Arun Sivananthan
- Department of Surgery and Cancer, Imperial College London, London W2 1NY, United Kingdom
| | - Georgina Kerry
- Liver Intensive Care Unit, King’s College Hospital NHS Foundation Trust, London SE5 9RS, United Kingdom
| | - Ara Darzi
- Department of Surgery and Cancer, Imperial College London, London W2 1NY, United Kingdom
| | - Kinesh Patel
- Gastroenterology, Chelsea and Westminster NHS Foundation Trust, London SW10 9NH, United Kingdom
| | - Nisha Patel
- Department of Surgery and Cancer, Imperial College London, London W2 1NY, United Kingdom
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Machaku D, Suleman M, Mduma E, Nkoronko M. Valentino's syndrome: a bizarre clinical presentation. J Surg Case Rep 2023; 2023:rjad035. [PMID: 36755937 PMCID: PMC9902202 DOI: 10.1093/jscr/rjad035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Accepted: 01/17/2023] [Indexed: 02/09/2023] Open
Abstract
A perforated peptic or duodenal ulcer may cause an unusual expression of right lower quadrant pain. In Valentino's syndrome, the chemical fluid from the ulcer flows via the right paracolic gutter to the right iliac fossa, causing peritoneal irritation and chemical appendicitis which will mimic pain in the right lower quadrant. We report a case of a 23-year-old male patient who presented with cramping lower abdominal pain with fevers and vomiting. His pain was mostly in the right lower quadrant and radiated to his back. A perforation-related pneumoperitoneum was found on a computed tomography scan, along with an accumulation of fluid in the abdomen and thickening of the pyloric antrum. Valentino's syndrome's aberrant clinical picture mimicking acute appendicitis is a pathognomonic presentation of the disease. Right lower abdominal pain should also prompt the scrutiny of atypical differentials, such as perforated ulcers. Physicians need to manage these patients with a high index of suspicion.
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Affiliation(s)
| | - Mujaheed Suleman
- General Surgery, Kilimanjaro Christian Medical Center, Kilimanjaro, Tanzania,Kilimanjaro Christian Medical University College, Kilimanjaro, Tanzania
| | - Elias Mduma
- General Surgery, Kilimanjaro Christian Medical Center, Kilimanjaro, Tanzania,Kilimanjaro Christian Medical University College, Kilimanjaro, Tanzania
| | - Mugisha Nkoronko
- General Surgery, Kilimanjaro Christian Medical Center, Kilimanjaro, Tanzania
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Dahiya DS, Mandoorah S, Gangwani MK, Ali H, Merza N, Aziz M, Singh A, Perisetti A, Garg R, Cheng CI, Dutta P, Inamdar S, Sanaka MR, Al-Haddad M. A Comparative Analysis of Bleeding Peptic Ulcers in Hospitalizations With and Without End-Stage Renal Disease. Gastroenterology Res 2023; 16:17-24. [PMID: 36895703 PMCID: PMC9990529 DOI: 10.14740/gr1605] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2023] [Accepted: 02/13/2023] [Indexed: 03/11/2023] Open
Abstract
Background End-stage renal disease (ESRD) patients are highly susceptible to peptic ulcer bleeding (PUB). We aimed to assess the influence of ESRD status on PUB hospitalizations in the United States (USA). Methods We analyzed the National Inpatient Sample to identify all adult PUB hospitalizations in the USA from 2007 to 2014, which were divided into two subgroups based on the presence or absence of ESRD. Hospitalization characteristics and clinical outcomes were compared. Furthermore, predictors of inpatient mortality for PUB hospitalizations with ESRD were identified. Results Between 2007 and 2014, there were 351,965 PUB hospitalizations with ESRD compared to 2,037,037 non-ESRD PUB hospitalizations. PUB ESRD hospitalizations had a higher mean age (71.6 vs. 63.6 years, P < 0.001), and proportion of ethnic minorities i.e., Blacks, Hispanics, and Asians compared to the non-ESRD cohort. We also noted higher all-cause inpatient mortality (5.4% vs. 2.6%, P < 0.001), rates of esophagogastroduodenoscopy (EGD) (20.7% vs. 19.1%, P < 0.001), and mean length of stay (LOS) (8.2 vs. 6 days, P < 0.001) for PUB ESRD hospitalizations compared to the non-ESRD cohort. After multivariate logistic regression analysis, Whites with ESRD had higher odds of mortality from PUB compared to Blacks. Furthermore, the odds of inpatient mortality from PUB decreased by 0.6% for every 1-year increase in age for hospitalizations with ESRD. Compared to the 2011 - 2014 study period, the 2007 - 2010 period had 43.7% higher odds (odds ratio (OR): 0.696, 95% confidence interval (CI): 0.645 - 0.751) of inpatient mortality for PUB hospitalizations with ESRD. Conclusions PUB hospitalizations with ESRD had higher inpatient mortality, EGD utilization, and mean LOS compared to non-ESRD PUB hospitalizations.
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Affiliation(s)
- Dushyant Singh Dahiya
- Department of Internal Medicine, Central Michigan University College of Medicine, Saginaw, MI, USA.,These authors contributed equally to this article
| | - Sohaib Mandoorah
- Division of Pulmonary and Critical Care Medicine, Central Michigan University College of Medicine, Saginaw, MI, USA.,These authors contributed equally to this article
| | - Manesh Kumar Gangwani
- Department of Internal Medicine, The University of Toledo Medical Center, Toledo, OH, USA
| | - Hassam Ali
- Department of Internal Medicine, East Carolina University, Greenville, NC, USA
| | - Nooraldin Merza
- Department of Internal Medicine, The University of Toledo Medical Center, Toledo, OH, USA
| | - Muhammad Aziz
- Department of Gastroenterology and Hepatology, The University of Toledo Medical Center, Toledo, OH, USA
| | - Amandeep Singh
- Department of Gastroenterology, Hepatology and Nutrition, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Abhilash Perisetti
- Division of Gastroenterology and Hepatology, Kansas City Veterans Affairs Medical Center, Kansas City, MO, USA
| | - Rajat Garg
- Department of Gastroenterology, Hepatology and Nutrition, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Chin-I Cheng
- Department of Statistics, Actuarial and Data Science, Central Michigan University, Mt Pleasant, MI, USA
| | - Priyata Dutta
- Department of Internal Medicine, Trinity Health, Ann Arbor, MI, USA
| | - Sumant Inamdar
- Department of Gastroenterology and Hepatology, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Madhusudhan R Sanaka
- Department of Gastroenterology, Hepatology and Nutrition, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Mohammad Al-Haddad
- Division of Gastroenterology and Hepatology, Indiana University School of Medicine Indianapolis, IN, USA
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Tsao LC, Lin J, Lin KH, Ng SY, Huang CY, Hung YJ, Wu SC, Gao SL, Yu SF, Lin CC, Chang WJ. Saline irrigation versus gauze wiping and suction only for peritoneal decontamination during laparoscopic repair for perforated peptic ulcer disease. Sci Rep 2023; 13:1170. [PMID: 36670125 PMCID: PMC9860010 DOI: 10.1038/s41598-023-27471-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Accepted: 01/02/2023] [Indexed: 01/22/2023] Open
Abstract
The aim of current single-center study was to compare the short-term outcome of suction and gauze wiping alone versus the irrigation and suction technique for peritoneal decontamination among patients who underwent laparoscopic repair of PPU. Using data from our institution's prospectively maintained database, 105 patients who underwent laparoscopic repair were enrolled in this study. The participants were further divided into the group who received peritoneal irrigation (irrigation group, n = 67) and group who received gauze wiping and suction only (suction only group, n = 38). The irrigation group had a longer operative time (140 vs. 113 min, p = 0.0001), higher number of drainage tubes (38.8% vs. 0%, p < 0.0001) and a higher incidence of intra-abdominal abscess (10.4% vs. 0%, p = 0.0469) than the suction only group. Peritoneal irrigation may be associated with a prolonged operative time and a higher number of abdominal drains. Meanwhile, gauze wiping and suction may be sufficient for peritoneal decontamination during the laparoscopic repair of PPU as further infectious complications are not observed.
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Affiliation(s)
- Lien-Cheng Tsao
- Department of General Surgery, Changhua Christian Hospital, Changhua, 500, Taiwan
- Institute of Biomedical Science, College of Life Sciences, National Chung-Hsing University, Taichung, 402, Taiwan
| | - Joseph Lin
- Department of General Surgery, Changhua Christian Hospital, Changhua, 500, Taiwan
- Department of Animal Science and Biotechnology, Tunghai University, Taichung, 407, Taiwan
- Department of General Surgery, Yuanlin Christian Hospital, Yuanlin, 510, Taiwan
| | - Kuo-Hua Lin
- Department of General Surgery, Changhua Christian Hospital, Changhua, 500, Taiwan
| | - Sze-Yuin Ng
- Department of General Surgery, Changhua Christian Hospital, Changhua, 500, Taiwan
| | - Cheng-Yen Huang
- Department of General Surgery, Changhua Christian Hospital, Changhua, 500, Taiwan
| | - Yu-Ju Hung
- Department of General Surgery, Changhua Christian Hospital, Changhua, 500, Taiwan
| | - Szu-Chia Wu
- Transplant Medicine and Surgery Research Center, Changhua Christian Hospital, Changhua, 500, Taiwan
| | - Shih-Ling Gao
- Department of Nursing, Changhua Christian Hospital, Changhua, 500, Taiwan
| | - Shu-Fen Yu
- Department of Nursing, Changhua Christian Hospital, Changhua, 500, Taiwan
| | - Chi-Chien Lin
- Institute of Biomedical Science, College of Life Sciences, National Chung-Hsing University, Taichung, 402, Taiwan.
- Department of Medical Research, China Medical University Hospital, Taichung, 404, Taiwan.
- Department of Pharmacology, College of Medicine, Kaohsiung Medical University, Kaohsiung, 807, Taiwan.
| | - Wei-Jung Chang
- Department of General Surgery, Changhua Christian Hospital, Changhua, 500, Taiwan.
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Mulder WW, Arko-Cobbah E, Joubert G. Are admission laboratory values in isolation meaningful for predicting surgical outcome in patients with perforated peptic ulcers? Surg Open Sci 2022; 11:62-68. [PMID: 36570627 PMCID: PMC9768370 DOI: 10.1016/j.sopen.2022.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 11/10/2022] [Accepted: 11/30/2022] [Indexed: 12/12/2022] Open
Abstract
Background The study aimed to calculate the predictive value of admission laboratory values in patients with perforated peptic ulcers. Methods A retrospective, cohort analytical, observational study was performed, including patients with surgically confirmed perforated peptic ulcers over a 5-year period. Demographic data and admission laboratory values were collected from hospital electronic databases. Outcomes measured were in-hospital mortality, intensive care unit (ICU) admission and length of stay. The significance of categorical variables was calculated by chi-square and Fisher's exact test. Logistic regression analysis was performed to determine univariately statistically significant variables. Results In total, 188 patients met the inclusion criteria. The median age was 46 (range 15-87) years with a male predominance of 71.3 % (n = 134). The median length of hospital stay was 7 (range 1-94) days and 31.4 % (n = 59) of patients were admitted to the ICU. Post-operative in-hospital mortality was 25.0 % (n = 47). Predicting the categorical outcome of in-hospital mortality, abnormal haemoglobin, platelet count, urea, creatinine and potassium levels were all found to be statistically significant in the univariate analysis. Age (odds ratio [OR] 1.03), haemoglobin (OR 4.36) and creatinine (OR 7.76) levels were significant in the multivariate analysis. Conclusions Mortality rate among patients with perforated peptic ulcer disease is still substantial. Admission laboratory values showed statistical significance as outcome indicators and were valuable to assist in predicting the prognosis. An abnormally high serum creatinine level was the strongest single predictor of both mortality and ICU admission. Key message Initial laboratory findings of patients admitted for perforated peptic ulcer showed that an abnormally high serum creatinine level was the strongest single predictor of both mortality and ICU admission.
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Affiliation(s)
- Wikus W. Mulder
- Department of Surgery, School of Clinical Medicine, Faculty of Health Sciences, University of the Free State, Bloemfontein, South Africa,Corresponding author at: Department of Surgery, Faculty of Health Sciences, University of the Free State, 2015 Nelson Mandela Drive, Bloemfontein 9300, South Africa.
| | - Emmanuel Arko-Cobbah
- Department of Surgery, School of Clinical Medicine, Faculty of Health Sciences, University of the Free State, Bloemfontein, South Africa
| | - Gina Joubert
- Department of Biostatistics, School of Biomedical Sciences, Faculty of Health Sciences, University of the Free State, Bloemfontein, South Africa
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Idris M, Smiley A, Patel S, Latifi R. Risk Factors for Mortality in Emergently Admitted Patients with Acute Gastric Ulcer: An Analysis of 15,538 Patients in National Inpatient Sample, 2005-2014. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:16263. [PMID: 36498337 PMCID: PMC9736004 DOI: 10.3390/ijerph192316263] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/22/2022] [Revised: 11/26/2022] [Accepted: 12/01/2022] [Indexed: 06/17/2023]
Abstract
Background: Patients admitted emergently with a primary diagnosis of acute gastric ulcer have significant complications including morbidity and mortality. The objective of this study was to assess the risk factors of mortality including the role of surgery in gastric ulcers. Methods: Adult (18−64-year-old) and elderly (≥65-year-old) patients admitted emergently with hemorrhagic and/or perforated gastric ulcers, were analyzed using the National Inpatient Sample database, 2005−2014. Demographics, various clinical data, and associated comorbidities were collected. A stratified analysis was combined with a multivariable logistic regression model to assess predictors of mortality. Results: Our study analyzed a total of 15,538 patients, split independently into two age groups: 6338 adult patients and 9200 elderly patients. The mean age (SD) was 50.42 (10.65) in adult males vs. 51.10 (10.35) in adult females (p < 0.05). The mean age (SD) was 76.72 (7.50) in elderly males vs. 79.03 (7.80) in elderly females (p < 0.001). The percentage of total deceased adults was 1.9% and the percentage of total deceased elderly was 3.7%, a difference by a factor of 1.94. Out of 3283 adult patients who underwent surgery, 32.1% had perforated non-hemorrhagic ulcers vs. 1.8% in the non-surgical counterparts (p < 0.001). In the 4181 elderly surgical patients, 18.1% had perforated non-hemorrhagic ulcers vs. 1.2% in the non-surgical counterparts (p < 0.001). In adult patients managed surgically, 2.6% were deceased, while in elderly patients managed surgically, 5.5% were deceased. The mortality of non-surgical counterparts in both age groups were lower (p < 0.001). The multivariable logistic regression model for adult patients electing surgery found delayed surgery, frailty, and the presence of perforations to be the main risk factors for mortality. In the regression model for elderly surgical patients, delayed surgery, frailty, presence of perforations, the male sex, and age were the main risk factors for mortality. In contrast, the regression model for adult patients with no surgery found hospital length of stay to be the main risk factor for mortality, whereas invasive diagnostic procedures were protective. In elderly non-surgical patients, hospital length of stay, presence of perforations, age, and frailty were the main risk factors for mortality, while invasive diagnostic procedures were protective. The following comorbidities were associated with gastric ulcers: alcohol abuse, deficiency anemias, chronic blood loss, chronic heart failure, chronic pulmonary disease, hypertension, fluid/electrolyte disorders, uncomplicated diabetes, and renal failure. Conclusions: The odds of mortality in emergently admitted geriatric patients with acute gastric ulcer was two times that in adult patients. Surgery was a protective factor for patients admitted emergently with gastric perforated non-hemorrhagic ulcers.
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Affiliation(s)
- Maksat Idris
- New York Medical College, School of Medicine and Westchester Medical Center, Valhalla, NY 10595, USA
| | - Abbas Smiley
- New York Medical College, School of Medicine and Westchester Medical Center, Valhalla, NY 10595, USA
| | - Saral Patel
- New York Medical College, School of Medicine and Westchester Medical Center, Valhalla, NY 10595, USA
| | - Rifat Latifi
- Department of Surgery, University of Arizona, Tucson, AZ 85721, USA
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Chalise A, Kathayat LB, Poudel P, Rajbhandari AP, Koirala R. Right lower quadrant abdominal mass: A case report. Clin Case Rep 2022; 10:e6544. [PMID: 36381037 PMCID: PMC9638037 DOI: 10.1002/ccr3.6544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Revised: 10/18/2022] [Accepted: 10/19/2022] [Indexed: 11/09/2022] Open
Abstract
Right lower quadrant mass in the abdomen has many causes, but gastric perforation is rare. We discuss a 65-year-old lady who presented with a history of pain in her abdomen followed by swelling in her right lower abdomen. During the evaluation, a diagnosis of gastric perforation was made.
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Affiliation(s)
- Anup Chalise
- Nepal Medical College and Teaching HospitalKathmanduNepal
| | | | - Prabhat Poudel
- Nepal Medical College and Teaching HospitalKathmanduNepal
| | | | - Rabin Koirala
- Nepal Medical College and Teaching HospitalKathmanduNepal
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36
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Rodrigo VEU, de Silva GPUP, Jayasinghe DSH, Thalagaspitiya SPB, Srishankar S, Wickramarathne D, Karunadasa MSE. Valentino's syndrome: A rare and lethal differential diagnosis for acute appendicitis. SAGE Open Med Case Rep 2022; 10:2050313X221132069. [PMID: 36324598 PMCID: PMC9618742 DOI: 10.1177/2050313x221132069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2022] [Accepted: 09/23/2022] [Indexed: 11/07/2022] Open
Abstract
Due to the rarity of the condition, Valentino’s syndrome is an underrated differential diagnosis for acute appendicitis. We describe a patient with Valentino’s syndrome in whom preoperative and intraoperative diagnoses were challenging due to misleading clinical, investigative, and morphological findings. A 31-year-old woman who was on methylprednisolone for sensory radiculopathy presented to the emergency department with acute right lower quadrant pain. The clinical diagnosis of acute appendicitis was supported by the elevated inflammatory markers and ultrasonographic findings. An appendicectomy and an ovarian cystectomy were performed due to the findings of mild appendicitis and right ovarian endometrioma, respectively. Postoperatively, she developed peritonitis with a purulent bile-stained discharge from the surgical site and per vagina. Contrast-enhanced computed tomography of the abdomen showed a retroperitoneal collection at the second lumbar vertebral level extending along the right paracolic gutter to the pelvis and intraperitoneal fluid collections in right lower quadrant and pelvis. An emergency exploratory laparotomy confirmed a perforation at the posterior aspect of the duodenum which was repaired with an omental patch. Unfortunately, relaparotomy and end ileostomy were required due to colonic perforation with the eroded drain tube. She made an uneventful recovery with intensive care and underwent ileostomy reversal after 12 weeks. We emphasize the clues to have a high degree of suspicion during preoperative and intraoperative evaluation to recognize this lethal mimicker of acute appendicitis.
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Affiliation(s)
- VEU Rodrigo
- Postgraduate Institute of Medicine, University of Colombo, Colombo, Sri Lanka
| | - GPUP de Silva
- Colombo South Teaching Hospital, Dehiwala-Mount Lavinia, Sri Lanka,GPUP de Silva, Colombo South Teaching Hospital, Dehiwala-Mount Lavinia, Sri Lanka.
| | - DSH Jayasinghe
- Professorial Surgical Unit, Teaching Hospital Anuradhapura, Anuradhapura, Sri Lanka
| | - SPB Thalagaspitiya
- Professorial Surgical Unit, Teaching Hospital Anuradhapura, Anuradhapura, Sri Lanka
| | - S Srishankar
- Professorial Surgical Unit, Teaching Hospital Anuradhapura, Anuradhapura, Sri Lanka
| | | | - MSE Karunadasa
- Faculty of Medicine, Wayamba University of Sri Lanka, Kuliyapitiya, Sri Lanka
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Tartaglia D, Strambi S, Coccolini F, Mazzoni A, Miccoli M, Cremonini C, Cicuttin E, Chiarugi M. Laparoscopic versus open repair of perforated peptic ulcers: analysis of outcomes and identification of predictive factors of conversion. Updates Surg 2022; 75:649-657. [PMID: 36192594 PMCID: PMC10042947 DOI: 10.1007/s13304-022-01391-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2021] [Accepted: 08/25/2022] [Indexed: 10/10/2022]
Abstract
BACKGROUND The surgical treatment for perforated peptic ulcers (PPUs) can be safely performed laparoscopically. This study aimed to compare the outcomes of patients who received different surgical approaches for PPU and to identify the predictive factors for conversion to open surgery. METHODS This retrospective study analyzed patients treated for PPUs from 2002 to 2020. Three groups were identified: a complete laparoscopic surgery group (LG), a conversion to open group (CG), and a primary open group (OG). After univariate comparisons, a multivariate analysis was conducted to identify the predictive factors for conversion. RESULTS Of the 175 patients that underwent surgery for PPU, 104 (59.4%) received a laparoscopic-first approach, and 27 (25.9%) required a conversion to open surgery. Patients treated directly with an open approach were older (p < 0.0001), had more comorbidities (p < 0.0001), and more frequently had a previous laparotomy (p = 0.0001). In the OG group, in-hospital mortality and ICU need were significantly higher, while the postoperative stay was longer. Previous abdominal surgery (OR 0.086, 95% CI 0.012-0.626; p = 0.015), ulcer size (OR 0.045, 95% CI 0.010-0.210; p < 0.0001), and a posterior ulcer location (OR 0.015, 95% CI 0.001-0.400; p = 0.012) were predictive factors for conversion to an open approach. CONCLUSION This study confirms the benefits of the laparoscopic approach for the treatment of PPUs. Previous laparotomies, a greater ulcer size, and a posterior location of the ulcer are risk factors for conversion to open surgery during laparoscopic repair.
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Affiliation(s)
- Dario Tartaglia
- Emergency Surgery Unit, New Santa Chiara Hospital, University of Pisa, Via Paradisa, 2, 56021, Pisa, Italy.
| | - Silvia Strambi
- Emergency Surgery Unit, New Santa Chiara Hospital, University of Pisa, Via Paradisa, 2, 56021, Pisa, Italy
| | - Federico Coccolini
- Emergency Surgery Unit, New Santa Chiara Hospital, University of Pisa, Via Paradisa, 2, 56021, Pisa, Italy
| | - Alessio Mazzoni
- Emergency Surgery Unit, New Santa Chiara Hospital, University of Pisa, Via Paradisa, 2, 56021, Pisa, Italy
| | - Mario Miccoli
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Camilla Cremonini
- Emergency Surgery Unit, New Santa Chiara Hospital, University of Pisa, Via Paradisa, 2, 56021, Pisa, Italy
| | - Enrico Cicuttin
- Emergency Surgery Unit, New Santa Chiara Hospital, University of Pisa, Via Paradisa, 2, 56021, Pisa, Italy
| | - Massimo Chiarugi
- Emergency Surgery Unit, New Santa Chiara Hospital, University of Pisa, Via Paradisa, 2, 56021, Pisa, Italy
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Oikonomou D, Bottazzoli E, Damaskos D, Di Saverio S. Laparoscopic distal gastric and D1 resection for large perforated duodenal bulb peptic ulcer, with intracorporeal antecolic gastrojejunal anastomosis. Surg Endosc 2022; 36:6997-6999. [PMID: 34997347 DOI: 10.1007/s00464-021-08955-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Accepted: 12/06/2021] [Indexed: 06/14/2023]
Abstract
BACKGROUND Peptic ulcer perforation is a common surgical emergency and a major cause of death especially in elderly patients, despite the fact of the presence of effective drug treatments and an increased understanding of its etiology. Giant duodenal perforations, in particular, pose a significant challenge and there is scarce data regarding their optimal management. Laparoscopic surgery is advocated in the surgical treatment of perforated duodenal ulcer disease, in experienced hands. METHODS Herein we present an 84-year-old man with past medical history of type II diabetes mellitus and hypertension who was admitted to our Department due to epigastric pain and diffuse peritonitis. CT scan revealed the presence of a significant amount of free air and fluid in the upper abdomen secondary to a duodenal perforation. RESULTS The patient was taken immediately to the theater for an urgent laparoscopy. Methylene blue via the NG tube better defined the extent of the duodenal perforation which was not amenable to a primary repair. Consequently, a decision was made for a laparoscopic pancreas-sparing, ampulla preserving gastroduodenectomy with intracorporeal Billroth II gastrojejunal anastomosis. The postoperative period was uneventful and the patient was discharged on the 13th postoperative day. Histopathology revealed a large benign duodenal ulcer. CONCLUSIONS Although the incidence of peptic ulcer disease is decreasing, it appears that the incidence of complications is rising. Laparoscopic approach, especially when performed by laparoscopic surgery experts, could be a treatment option for difficult duodenal ulcer perforations with less pain, shorter hospital stay and reduced morbidity.
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Affiliation(s)
| | - Elisa Bottazzoli
- Department of General, Emergency and Transplant Surgery, University of Insubria, Varese, Italy
| | - Dimitrios Damaskos
- Department of General Surgery, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Salomone Di Saverio
- Department of General Surgery, ASUR Marche, AV5, Hospital of San Benedetto del Tronto (AP), San Benedetto del Tronto, Italy.
- Dipartimento di Chirurgia Generale e Specialistica "Paride Stefanini", La Sapienza University of Rome, Rome, Italy.
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Pneumoperitoneum in Perforated Appendicitis in the COVID Pandemic:A Case Report. INTERNATIONAL JOURNAL OF SURGERY OPEN 2022. [DOI: 10.1016/j.ijso.2022.100469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Singh PK, Easwari TS. Emerging Trends and their Impacts on Peptic Ulcer Diseases: Treatments and Techniques. CURRENT DRUG THERAPY 2022. [DOI: 10.2174/1574885517666220307115813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Background:
Peptic ulcer disease (PUD) is prevalent in almost all parts of the world. PUD complications are creating a major source of preventable health care expenses. The major factors responsible for the incidence of PUD and its complication have changed over the past few decades after the identification of non-steroidal inflammatory drugs (NSAIDs) and Helicobacter pylori bacterial infection along with a marked increase in the use of proton-pump inhibitors (PPIs) as drug therapy. The management of PUD has become more complex and challenging due to antimicrobial resistance.
Objective:
The objective of the study was to highlight current therapy and novel techniques used in the treatment of peptic ulcer diseases.
Methods:
An exhaustive literature search has been conducted across PubMed, Google, Scopus and Web of Science as an electronic database to add the crucial information from the relevant literature.
Results:
In the present review, we have discussed PUD and its pathophysiology. The recent trends in PUD and possible treatments with novel techniques have also been discussed. The type and presence of ulcers cannot be predicted accurately based on symptoms. The available treatment approaches for peptic ulcers based on their clinical presentation and etiology are anti-secretary therapy, endoscopy to reveal ulcers followed by drug therapy, and triple therapy for H pylori infection.
Conclusion:
Thus, the popular and effective methods are very beneficial in controlling PUD. The treatment based on diagnosis is the foremost requirement for ameliorating any disorder. In this article, the emerging techniques and development in the treatment and diagnosis of PUD have been reviewed.
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Affiliation(s)
- Pranjal Kumar Singh
- Department of Pharmaceutics, IIMT College of Medical Sciences, IIMT University, Meerut, Uttar Pradesh, India
| | - T. S. Easwari
- Department of Pharmaceutics, IIMT College of Medical Sciences, IIMT University, Meerut, Uttar Pradesh, India
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Mahajan PS, Abdulmajeed H, Aljafari A, Kolleri JJ, Dawdi SA, Mohammed H. A Cautionary Tale: Unveiling Valentino’s Syndrome. Cureus 2022; 14:e22667. [PMID: 35371708 PMCID: PMC8965196 DOI: 10.7759/cureus.22667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/27/2022] [Indexed: 11/05/2022] Open
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Tofigh AM, Family S. Primary versus delayed primary skin closure in operated patients due to perforated peptic ulcer disease: a randomized controlled clinical trial. Langenbecks Arch Surg 2022; 407:1471-1478. [PMID: 35088142 DOI: 10.1007/s00423-021-02405-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Accepted: 12/03/2021] [Indexed: 01/02/2023]
Abstract
PURPOSE Perforated peptic ulcer (PPU) is a life-threatening complication of peptic ulcer disease. This condition is characterized by a dirty abdomen that predisposes to postoperative wound infection. Delayed primary skin closure is occasionally preferred over primary closure to reduce the risk of surgical site infection in dirty abdominal wounds. In primary skin closure, the skin is sutured immediately after surgery. Meanwhile, in delayed primary skin closure, the incision is left open, and sutured after 2-5 days. The current research aimed to compare the risk for surgical site infection, length of hospitalization, and mortality rate between primary versus delayed primary skin closure among patients who underwent surgery for PPU. METHODS This single-blind randomized clinical trial included 120 patients who were randomly allocated into the primary and delayed primary closure groups. A research assistant who was blinded to the study examined the wounds for surgical site infection based on the 1992 Center for Disease Control criteria. The outcomes were mortality rate and duration of hospitalization. RESULTS The delayed primary and primary closure groups did not significantly differ in terms of postsurgical wound infection occurring on the 3rd, 7th, 14th, and 30th days after surgery, mortality rate, and duration of hospitalization. CONCLUSION In patients who underwent surgery for PPU, delayed primary closure is not recommended over primary closure due to the risk of postoperative surgical site infection.
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Affiliation(s)
- Arash Mohammadi Tofigh
- Department of General Surgery, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Shervan Family
- Department of Surgery, Imam Hossein Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Wang YL, Chan XW, Chan KS, Shelat VG. Omental patch repair of large perforated peptic ulcers ≥25 mm is associated with higher leak rate. J Clin Transl Res 2021; 7:759-766. [PMID: 34988327 PMCID: PMC8710357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Revised: 11/02/2021] [Accepted: 11/07/2021] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND AND AIM Omental patch repair is the present gold-standard technique for patients with perforated peptic ulcers (PPUs). Data are lacking regarding the safe ulcer size for omental patch repair leak (OPL). We analyze our experience in managing PPU to identify an ulcer size cut-off for predicting OPL. METHODS Patients who had undergone omental patch repair for PPU between Jan 2004 and Apr 2016 were included. Demographic data, the American Society of Anesthesiologists score, ulcer size, operative approach, post-operative complications, and length of stay were recorded. OPL, intra-abdominal collection, repeat surgery, and 30-day mortality were recorded. The relationship between ulcer size, pre-operative characteristics, and OPL were investigated with univariate and multivariate logistic regression. Receiver operating characteristic curve analysis derived the ulcer size cut-off to predict OPL. In addition, we analyzed if ulcer size predicted mortality or malignancy. RESULTS Six hundred and ninety patients with a mean age of 55.1 years (range 16-94) were managed for PPU during the study period. Free air on X-ray was evident in 417 (60.4%) patients. Mean ulcer size was 7.8 mm (range 1-50). OPL occurred in 15 patients (2.2%) and 30-day mortality was 7.4% (n=51). Multivariate analysis found ulcer size increase of 10 mm (OR 3.30, 95% CI 1.81-6.02, P<0.001) predicted increased risk of OPL. At 25 mm cut-off, sensitivity was 26.7%, specificity was 97.2%, positive likelihood ratio was 9.47, and negative likelihood ratio was 0.76 for OPL. CONCLUSION Ulcer size increase in 10 mm increases leak rate by 3.3 times. Ulcer size ≥25 mm predicts OPL. RELEVANCE FOR PATIENTS Increased risk of OPL for ≥25 mm warrants need for close post-operative monitoring and lowers threshold for investigations in event of clinical deterioration. Decision for omental patch repair versus gastrectomy however should not be based on ulcer size alone.
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Affiliation(s)
- Yi Liang Wang
- Department of General Surgery, Khoo Teck Puat Hospital, Singapore
| | - Xue Wei Chan
- Department of General Surgery, Tan Tock Seng Hospital, Singapore
| | - Kai Siang Chan
- Department of General Surgery, Tan Tock Seng Hospital, Singapore
| | - Vishal G. Shelat
- Department of General Surgery, Tan Tock Seng Hospital, Singapore
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MubarakAli D, Akshaya T, Sathya R, Irfan N. Study on the Interaction of Algal Peptides on Virulence Factors of Helicobacter pylori: In Silico Approach. Appl Biochem Biotechnol 2021; 194:37-53. [PMID: 34762267 PMCID: PMC8581125 DOI: 10.1007/s12010-021-03716-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Accepted: 10/08/2021] [Indexed: 11/25/2022]
Abstract
In the Asian region, Helicobacter pylori infects about 80% populations, which is most leading cause of peptic ulcers, and it is an asymptomatic infection. Studies reported that the particular bacteria carry specific virulence factors that leads to severe complications. These virulence factors can be used as a drug targets to inhibit their growth and pathogenicity. Chronic infection with H. pylori virulence factors are CagA, VacA and HtrA positive strains the risk factor of gastric cancer. In this study, we aimed to study the antagonistic interaction pattern between the potential eight algal peptides against the virulence factors of H. pylori through in silico analysis intended to treat peptic ulcer and prevent the further complications such as cancer. The proteins of virulent factors are docked using C-Docker algorithm and calculated the bind energy of the complexes. The results showed that the peptide derived from a green alga, Tetradesmus sp. are active against the three virulent factors such as cag-A, vac-A, and Htr-A with multiple hydrogen, vdW, electrostatic interactions, and mild π-hydrophobic bindings with the libdock energy score for CagA, VacA and HtrA are 175.625, 158.603 and 89.397 kcal/mol. These primes and the peptide lead to develop a better and potential inhibitors against H. pylori infection.
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Affiliation(s)
- Davoodbasha MubarakAli
- School of Life Sciences, B.S. Abdur Rahman Crescent Institute of Science and Technology, Chennai, Tamil Nadu, India.
| | - Thirusangu Akshaya
- School of Life Sciences, B.S. Abdur Rahman Crescent Institute of Science and Technology, Chennai, Tamil Nadu, India
| | - Raghunathan Sathya
- School of Life Sciences, B.S. Abdur Rahman Crescent Institute of Science and Technology, Chennai, Tamil Nadu, India
| | - Navabshan Irfan
- Crescent School of Pharmacy, B.S. Abdur Rahman Crescent Institute of Science and Technology, Chennai, Tamil Nadu, India
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Liang TS, Zhang BL, Zhao BB, Yang DG. Low serum albumin may predict poor efficacy in patients with perforated peptic ulcer treated nonoperatively. World J Gastrointest Surg 2021; 13:1226-1234. [PMID: 34754390 PMCID: PMC8554729 DOI: 10.4240/wjgs.v13.i10.1226] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2021] [Revised: 06/15/2021] [Accepted: 08/16/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Nonoperative management (NOM) is a promising therapeutic modality for patients with perforated peptic ulcer (PPU). However, the risk factors for poor efficacy and adverse events of NOM are a concern.
AIM To investigate the factors predictive of poor efficacy and adverse events in patients with PPU treated by NOM.
METHODS This retrospective case-control study enrolled 272 patients who were diagnosed with PPU and initially managed nonoperatively from January 2014 to December 2018. Of these 272 patients, 50 converted to emergency surgery due to a lack of improvement (surgical group) and 222 patients were included in the NOM group. The clinical data of these patients were collected. Baseline patient characteristics and adverse outcomes were compared between the two groups. Logistic regression analysis and receiver operating characteristic curve analyses were conducted to investigate the factors predictive of poor efficacy of NOM and adverse outcomes in patients with PPU.
RESULTS Adverse outcomes were observed in 71 patients (32.0%). Multivariate analyses revealed that low serum albumin level was an independent predictor for poor efficacy of NOM and adverse outcomes in patients with PPU.
CONCLUSION Low serum albumin level may be used as an indicator to help predict the poor efficacy of NOM and adverse outcomes, and can be used for risk stratification in patients with PPU.
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Affiliation(s)
- Tang-Shuai Liang
- Department of Gastrointestinal Surgery, Liaocheng People’s Hospital, Liaocheng 252000, Shandong Province, China
| | - Bao-Lei Zhang
- Department of Gastrointestinal Surgery, Liaocheng People’s Hospital, Liaocheng 252000, Shandong Province, China
| | - Bing-Bo Zhao
- Department of Gastrointestinal Surgery, Liaocheng People’s Hospital, Liaocheng 252000, Shandong Province, China
| | - Dao-Gui Yang
- Department of Gastrointestinal Surgery, Liaocheng People’s Hospital, Liaocheng 252000, Shandong Province, China
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No Abdominal Drainage After Single-Port Laparoscopic Repair for Perforated Duodenal Ulcers. Indian J Surg 2021. [DOI: 10.1007/s12262-021-02795-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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Seyoum N, Ethicha D, Assefa Z, Nega B. Risk Factors that Affect Morbidity and Mortality in Patients with Perforated Peptic Ulcer Diseases in a Teaching Hospital. Ethiop J Health Sci 2021; 30:549-558. [PMID: 33897215 PMCID: PMC8054450 DOI: 10.4314/ejhs.v30i4.10] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Background This study was done to identify risk factors that affect the morbidity and mortality of patients operated for a perforated peptic ulcer in a resource-limited setting. Methods A two years (January 1, 2016 -December 30, 2018) retrospective cross-sectional study was done on patients admitted and operated for PPU at Yekatit 12 Hospital, Addis Ababa, Ethiopia. Results A total of 93 patients were operated. The median age affected was 29 years (Range 15–75 years). Male to female ratio was 7.5:1. Chewing chat, smoking and alcohol use were seen in 22 (23.6%), 35(37.6%), and 34(36.5%), cases respectively. Only 23.6% gave previous history of dyspepsia. The median duration of illness was 48hours and the duodenal to gastric ulcer perforation ratio was 6.5:1. In majority of the cases (63.3%) the perforation diameter was =10mm (63.3%). Cellan-Jones repair of the perforations was done in 92.5% of cases. A total of 47 complications were seen in 25 cases. The total complications and mortality rates were 25(26.8%) and 6(6.5%) respectively. The most common postoperative complication was pneumonia (13.97%) followed by superficial surgical site infection (10.8%). Mortality rate was highest among patients >50yrs [AOR (95%CI) =2.4(230)]. Delayed presentation of >24 hours [AOR (95%CI) =4.3(1.4–13.5)] and a SBP =90mmhg [AOR (95%CI) =4.8(1–24)] were found to be significantly related with higher complication rate. Conclusions Patients who presented early and immediate corrective measures were instituted had better outcomes while those seen late developed unfavorable out-come with significantly higher complications. Therefore, early detection and treatment of PPU is essential.
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Affiliation(s)
- Nebyou Seyoum
- Cardiothoracic Unit, Department of Surgery, School of Medicine, College of Health Sciences, Addis Ababa University, Ethiopia
| | - Daba Ethicha
- Cardiothoracic Unit, Department of Surgery, School of Medicine, College of Health Sciences, Addis Ababa University, Ethiopia
| | - Zelalem Assefa
- Cardiothoracic Unit, Department of Surgery, School of Medicine, College of Health Sciences, Addis Ababa University, Ethiopia
| | - Berhanu Nega
- Cardiothoracic Unit, Department of Surgery, School of Medicine, College of Health Sciences, Addis Ababa University, Ethiopia
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Sunnapwar A, Ojili V, Katre R, Shah H, Nagar A. Multimodality imaging of adult gastric emergencies: A pictorial review. Indian J Radiol Imaging 2021; 27:13-22. [PMID: 28515579 PMCID: PMC5385768 DOI: 10.4103/0971-3026.202957] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Acute gastric emergencies require urgent surgical or nonsurgical intervention because they are associated with high morbidity and mortality. Imaging plays an important role in diagnosis since the clinical symptoms are often nonspecific and radiologist may be the first one to suggest a diagnosis as the imaging findings are often characteristic. The purpose of this article is to provide a comprehensive review of multimodality imaging (plain radiograph, fluoroscopy, and computed tomography) of various life threatening gastric emergencies.
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Affiliation(s)
- Abhijit Sunnapwar
- Department of Body Imaging, University of Texas Health Science Center, San Antonio, Texas, USA
| | - Vijayanadh Ojili
- Department of Body Imaging, University of Texas Health Science Center, San Antonio, Texas, USA
| | - Rashmi Katre
- Department of Body Imaging, University of Texas Health Science Center, San Antonio, Texas, USA
| | - Hardik Shah
- Department of Body Imaging, University of Texas Health Science Center, San Antonio, Texas, USA
| | - Arpit Nagar
- Department of Body Imaging, Ohio State University Wexner Medical Center, Ohio, USA
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A Fast and Reliable Method to Interpret Short-Term Mortality in Perforated Peptic Ulcer: Red Cell Distribution Width is Sensitive and Specific. Surg Res Pract 2021; 2021:5542619. [PMID: 34056058 PMCID: PMC8149252 DOI: 10.1155/2021/5542619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Accepted: 05/05/2021] [Indexed: 11/25/2022] Open
Abstract
Introduction Peptic ulcer is an important health problem worldwide with a prevalence of around 5%. Peptic ulcer perforation is a potentially mortal complication of peptic ulcer disease. We aimed to investigate the potential use of red cell distribution width as a prognostic marker in peptic ulcer perforation. Methods The files, operation notes, biochemical and hematological parameters, and prognosis of patients who were operated for a peptic ulcer perforation were reviewed in a retrospective cohort study. The relation of red cell distribution width (RDW) to main outcome in-hospital mortality was assessed. Results The mean age of the 172 patients was 40 ± 17.89. There were 158 (92%) males and 14 (8%) females. The in-hospital mortality was 8.7% (15/172). The median RDW in the group with mortality was 15.00 (interquartile range (IQR): 14.30–17.20) compared with the median RDW in the group with no mortality as 13.2 (IQR: 12.80–14.00, p ≤ 0.001). Receiver operator characteristic curves were plotted for RDW to identify nonsurvivors and yielded a significant area under the curve as 0.812 (95% confidence interval: 0.682–0.942). The sensitivity and specificity of RDW at a cutoff value of 14.25% were calculated with an accuracy of 81.98 (95% confidence interval: 75.40–87.41) as 80.00 (51.91–95.67) and 82.17 (75.27–87.81), respectively. Conclusion Increased RDW may be of use to interpret mortality in patients with peptic ulcer perforation.
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Choi YS, Heo YS, Yi JW. Clinical Characteristics of Primary Repair for Perforated Peptic Ulcer: 10-Year Experience in a Single Center. J Clin Med 2021; 10:jcm10081790. [PMID: 33924059 PMCID: PMC8073572 DOI: 10.3390/jcm10081790] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 04/13/2021] [Accepted: 04/18/2021] [Indexed: 01/11/2023] Open
Abstract
Background: Perforated peptic ulcer (PPU) is a disease whose incidence is decreasing. However, PPU still requires emergency surgery. The aim of this study was to review the clinical characteristics of patients who received primary repair for PPU and identify the predisposing factors associated with severe complications. Method: From January 2011 to December 2020, a total of 75 patients underwent primary repair for PPU in our hospital. We reviewed the patients’ data, including general characteristics and perioperative complications. Surgical complications were evaluated using the Clavien-Dindo Classification (CDC) system, with which we classified patients into the mild complication (CDC 0–III, n = 61) and severe complication (CDC IV–V, n = 14) groups. Result: Fifty patients had gastric perforation, and twenty-five patients had duodenal perforation. Among surgical complications, leakage or fistula were the most common (5/75, 6.7%), followed by wound problems (4/75, 5.3%). Of the medical complications, infection (9/75, 12%) and pulmonary disorder (7/75, 9.3%) were common. Eight patients died within thirty days after surgery (8/75, 10.7%). Liver cirrhosis was the most significant predisposing factor for severe complications (HR = 44.392, p = 0.003). Conclusion: PPU is still a surgically important disease that has significant mortality, above 10%. Liver cirrhosis is the most important underlying disease associated with severe complications.
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Affiliation(s)
| | | | - Jin-Wook Yi
- Correspondence: ; Tel.: +82-32-890-3437; Fax: +82-32-890-3549
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