Palanisamy, S (2010) Non-traumatic Duodenal Ulcer Perforations at K.A.P.V Government Medical College and Annal Gandhi Memorial Government Hospital, Trichy. Masters thesis, K.A.P. Viswanatham Government Medical College, Tiruchirappalli.
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Abstract
INTRODUCTION: Despite the introduction of new drugs and various diagnostic tool, the number of patients with perforation of peptic ulcer remain stable in some countries whereas in some countries it is increasing. There are countries where rates of this complication show different trends depending on age and sex. The mortality has been reduced now a days due to early medical attention, quick diagnosis and prompt surgical management. But no single method of treatment is appropriate for every patient with perforated duodenal ulcer. There are different geographical trends in the duodenal ulcer disease and ulcer perforation. There are also great variations in the type of patients presenting with perforation in different parts of the world and management strategies also differ. The study was conducted with the aim of analyzing various factors which are of immense value in the diagnosis and management of the disease. The Present study was also carried out to evaluate the age, sex, seasonal periodicity, ulcer size, morbidity, mortality and further follow-up of the patients and anti H.pylori therapy. AIM OF STUDY: 1. To evaluate the age and sex incidence, socioeconomic status, seasonal trends, duration of signs and symptoms, associations with personal habits like alcohol and smoking, NSAIDs, dietary habits and other diseases in region like ours with particular reference to the prognosis of the patients with perforated duodenal ulcer. 2. To illustrate the various types of clinical presentation. 3. To study the methods of management in our hospital and to evaluate its outcome. 4. To study the diagnostic procedures in cases of perforated peptic ulcer. 5. To study the association of NSAIDs with perforated peptic ulcer. 6. To assess the incidence of post operative complications. 7. Long term review for; • Recurrence of ulcer perforation. • Post operative complications. • Anti H.pylori therapy. MATERIALS AND METHODS: Materials: Clinical Evaluation: Age, Sex, Socio Ec. Status, Alcohol, smoking, NSAIDS, Steroids, Dietary habits, Clinical features, Time of perforation, Duration of perforation, Previous ulcer History. INVESTIGATIONS: 1. Radiology, 2. Bl.Sugar, Bl.Urea Sr. Creatinine, Sr. Electrolytes, 3. Bl.Grouping, 4. ECG. OPERATIVE MANAGEMENT: 1. Operative findings, 2. Peritoneal Lavage and its role, 3. Conservative line of Management. FOLLOW UP: 1. Morbidity, 2. Mortality, 3. Anti H.pylori therapy – Recurrence. All the patients who were suspected to have duodenal perforation were admitted in the general surgical wards at AGMGH TRICHY. from June 2007 to November 2009. They were examined thoroughly and findings tabulated, operative reports reviewed and the following data were collected from the reports; Age and sex of patients, location of ulcer, symptoms and signs of perforation routine investigations like Hb%, Blood urea, Blood sugar, serum creatinine, blood grouping, serum electrolytes estimation, plain X ray abdomen in the erect posture, left lateral decubitus and abdominal paracentesis. STANDARD DRUG REGIMEN USED: Cefotaxime, Gentamicin, Metronidazole and Ranitidine were the standard drugs used. SCOPE OF STUDY: This study was undertaken with a view to analyses the different modes of presentation, age and sex incidence, etiology, various managements adapted its outcome in patients with duodenal perforation and was compared with those of other studies. OBSERVATION AND RESULTS: In the period between June 2007 to November 2009, 160 cases of perforated duodenal ulcer were admitted in the general surgical ward at Annal Gandhi memorial Govt. Medical College Hospital,Trichy. Since Trichy Medical College Hospital is a tertiary centre most of the cases were from Trichy town and from the adjacent towns of Kulithalai, Musiri, Manapparai, Perambalur, Srirangam, Lalkudi, Thuraiyur., etc. CONCLUSION: This study of 160 cases of duodenal ulcer perforation at the KAPV. GOVT Medical College and AGM Hospital, Trichy during the period of June 2007 November 2009 shows the following results: 1. Duodenal ulcer is common in our series. 2. Most common age group is between 31 to 50 years. 3. Males are more affected than females (8:1) 4. All the patients are of the low socio-economic group. 5. Perforation most commonly occurs in winter months - October, November, December and January (53%). 6. The most common predisposing factor is NSAID induced (42%). 7. In our study 100% of patients had pneumoperitoneum in radiographs. 8. Time of occurrence of perforation is predominantly in night and early morning (74%). 9. Majority of patients seek medical attention within 12 to 24 hours following perforation. 10. Site of perforation is most commonly the I part of duodenum. 11. Size of perforation in 64% of patients is between 0.5 to 1.0 cm. 12. Simple suture with live omental patch is done all cases. 13. Anti H.pylori therapy decreases recurrence during the follow up period. 14. Mortality is due to late presentation,large amount of purulent peritoneal fluid, elevated renal parameters and pulmonary complications.
| Item Type: | Thesis (Masters) |
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| Uncontrolled Keywords: | Non-traumatic Duodenal Ulcer Perforations ; K.A.P.V Government Medical College ; Annal Gandhi Memorial Government Hospital ; Triuchy |
| Subjects: | MEDICAL > General Surgery |
| Depositing User: | Devi S |
| Date Deposited: | 03 May 2018 04:15 |
| Last Modified: | 03 May 2018 11:11 |
| URI: | http://repository-tnmgrmu.ac.in/id/eprint/7408 |
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