Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2011 Aug;15(8):1329-35.
doi: 10.1007/s11605-011-1482-1. Epub 2011 May 13.

Trends in diagnosis and surgical management of patients with perforated peptic ulcer

Kenneth Thorsen  1 , Tom B Glomsaker, Andreas von Meer, Kjetil Søreide, Jon Arne Søreide
Affiliations

Trends in diagnosis and surgical management of patients with perforated peptic ulcer

Kenneth Thorsen et al. J Gastrointest Surg. 2011 Aug.

Abstract

Introduction: While the laparoscopic treatment of perforated peptic ulcers (PPU) has been shown to be feasible and safe, its implementation into routine clinical practice has been slow. Only a few studies have evaluated its overall utility. The aim of this study was to investigate changes in surgical management of PPU and associated outcomes.

Material and methods: The study was a retrospective, single institution, population-based review of all patients undergoing surgery for PPU between 2003 and 2009. Patient demographics, diagnostic evaluation, management, and outcomes were evaluated.

Results: Included were 114 patients with a median age of 67 years (range, 20-100). Women comprised 59% and were older (p < 0.001), had more comorbidities (p = 0.002), and had a higher Boey risk score (p = 0.036) compared to men. Perforation location was gastric/pyloric in 72% and duodenal in 28% of patients. Pneumoperitoneum was diagnosed by plain abdominal x-ray in 30 of 41 patients (75%) and by abdominal computerized tomography (CT) in 76 of 77 patients (98%; p < 0.001).Laparoscopic treatment was initiated in 48 patients (42%) and completed in 36 patients (75% of attempted cases). Laparoscopic treatment rate increased from 7% to 46% during the study period (p = 0.02). Median operation time was shorter in patients treated via laparotomy (70 min) compared to laparoscopy (82 min) and those converted from laparoscopy to laparotomy (105 min; p = 0.017). Postoperative complications occurred in 56 patients (49%). Overall 30-day postoperative mortality was 16%. No statistically significant differences were found in morbidity and mortality between open versus laparoscopic repair.

Conclusion: This study demonstrates an increased use of CT as the primary diagnostic tool for PPU and of laparoscopic repair in its surgical treatment. These changes in management are not associated with altered outcomes.

PubMed Disclaimer

Figures

Fig. 1
Fig. 1
Changes in preoperative abdominal imaging during the study period
Fig. 2
Fig. 2
Distribution of surgical approaches during the study period
See this image and copyright information in PMC

References

    1. Yeomans ND. Overview of 50 years’ progress in upper gastrointestinal diseases. J Gastroenterol Hepatol. 2009;24(Suppl 3):S2–S4. doi: 10.1111/j.1440-1746.2009.06064.x. - DOI - PubMed
    1. Quenot JP, Thiery N, Barbar S. When should stress ulcer prophylaxis be used in the ICU? Curr Opin Crit Care. 2009;15(2):139–143. doi: 10.1097/MCC.0b013e32832978e0. - DOI - PubMed
    1. Malfertheiner P, Chan FK, McColl KE. Peptic ulcer disease. Lancet. 2009;374(9699):1449–1461. doi: 10.1016/S0140-6736(09)60938-7. - DOI - PubMed
    1. Bertleff MJ, Lange JF. Perforated peptic ulcer disease: a review of history and treatment. Dig Surg. 2010;27(3):161–169. doi: 10.1159/000264653. - DOI - PubMed
    1. Møller MH, Adamsen S, Wojdemann M, Møller AM. Perforated peptic ulcer: how to improve outcome? Scand J Gastroenterol. 2009;44(1):15–22. doi: 10.1080/00365520802307997. - DOI - PubMed

MeSH terms