A study on factors predicting the outcome of perforated peptic ulcer; A Prospective study

Nandhagopal, T (2014) A study on factors predicting the outcome of perforated peptic ulcer; A Prospective study. Masters thesis, Madras Medical College, Chennai.


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BACKGROUND AND AIM: With the introduction of H2 receptor antagonists and proton pump inhibitors, the incidence of elective surgery for peptic ulcer (PU) diseases has decreased, although complications of PU such as perforation and bleeding have remained fairly constant. The purpose of this study was to identify the risk factors that predict morbidity and mortality in patients with perforated Peptic Ulcer METHODS: The following factors were recorded for 100 patients diagnosed and operated for perforated peptic ulcer and were analyzed in terms of morbidity and mortality: age, sex, personal habits of smoking and consuming alcohol, NSAID usage, past peptic ulcer history, co morbid illnesses, the duration of pain, duration between pain and surgery, duration between admission and surgery, surgery duration, shock and American Society of Anesthesiologist score, size, site of perforation, contamination, procedure and complications following the surgery. RESULTS: Age of 60 years and above had mortality of 46% and also this mortality is high within the first 48 hrs and up to 7 days. Average duration of hospital stay was 7 to 14 days. Female sex was more related to severe disease and mortality (100%). Duration of pain of 3 days had 35.7% and 4 or more 50% mortality. 82% of the patients had past history of peptic ulcer and on and off treatment. 16% of patients had history of NSAID usage before perforation. 48% of patients had the habit of both smoking and alcohol and 40% are neither smoking nor alcoholic. On physical examination 96% had respiratory distress, 80% had anemia, 38% had tachycardia, 26% both hypotension and tachycardia, and 36% had normal pulse and blood pressure. 94% had signs of peritonitis. 80% showed air under diaphragm in chest X ray. Preoperative lower respiratory infection had 40% mortality. Duration between pain and surgery that is preoperative delay of 48 to 72 hours had 31% and more than 72 hrs had 32% mortality. ASA score of 4 and 5 had 100% mortality and score of 3 had 64%. Gastric perforation (30%) has more mortality than duodenal (20%) perforation. Size of perforation more than 1 cm has 42% mortality. Contamination of more than 1 litre had related to 44% of death. Duration of the surgery more than 2 hours had significant effect on the mortality. 32% were in need of ventilator support and 24% were in need of circulatory support. 76% of patients had adequate renal function. 46% of the patients developed wound infection and 26% had wound dehiscence and underwent secondary suturing. Post operatively 20% patients had lower respiratory infection and 10% had ARDS leading to death. 24% of the patient had acute kidney injury and treated with supportive treatment. 14% of patients had developed multiple organ dysfunctions and died. Sepsis leading to shock and multiple organ dysfunctions is a cause of death. CONCLUSION: The following factors were associated with morbidity and mortality; Age more than 60 years, duration between initial pain and surgery of more than 48 hours, class III or more shock, ASA score of 3and more, size of more than 1 cm and contamination of more than 1 litre and the following factors were associated with mortality; Preoperative lower respiratory infection, duration of the surgery, Post operative lower respiratory infection, and Acute respiratory distress syndrome.

Item Type: Thesis (Masters)
Uncontrolled Keywords: perforated peptic ulcer ; peptic ulcer perforation ; prospective study.
Subjects: MEDICAL > General Surgery
Depositing User: Devi S
Date Deposited: 05 Jul 2018 03:43
Last Modified: 05 Jul 2018 03:54
URI: http://repository-tnmgrmu.ac.in/id/eprint/8624

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