A STUDY ON PATIENTS WITH PEPTIC ULCER PERFORATION WITH RESPECT TO AETIOLOGY AND FACTORS AFFECTING OUTCOME OF MANAGEMENT
Journal Title: Journal of Evolution of Medical and Dental Sciences - Year 2016, Vol 5, Issue 56
Abstract
BACKGROUND Perforation peritonitis is one of the commonest surgical emergency encountered by surgeons. The aim of the study is to provide an overview of aetiological factors causing peptic ulcer perforation and the factors affecting the outcome of management. MATERIALS AND METHODS This study was conducted at Mahathma Gandhi Memorial Hospital, Trichirapalli, between December 2014 and August 2015. This study included 81 cases of Peptic ulcer perforation who are managed with laparotomy or peritoneal drainage, were studied retrospectively for the factors causing peptic ulcer perforation, site of perforation, surgical management, complications and outcome and factors influencing outcome of management. Data analysed done by using SPSS 17 software with appropriate statistical test. RESULTS The incidence of Peptic ulcer perforation at MGM Hospital has been worked out to be <1% (0.74%). Peptic ulcer perforation is commonly seen in 5th decade of life; 65% of the cases in the age group of 25 to 55 years. The youngest patient was 15 years old and the oldest 70 years old. Male:Female ratio is 9:1. More commonly seen in people who are having blood group “O” constituting 49% of the total. Past history of peptic ulcer was present in 73% of cases of perforation; 65.4% of the cases are addicted to chronic smoking and 66.7% of the cases are addicted to alcohol; 94% were taking mixed diet. Family history of peptic ulcer was present in 32% of the cases of duodenal ulcer perforation; 94% patients consume diet with plenty of chillies and spices. Out of 73% of cases with past history of duodenal ulcer, 80-85% of patients had taken medical treatment with antacids and H2 receptor blockers, proton pump inhibitors drugs irregularly. Diagnosis was made on clinical history and physical examination of abdomen and aided by plain X-ray abdomen in erect posture, which showed pneumo-peritoneum in 96.3% of cases of duodenal ulcer perforations. Obliteration of liver dullness was present in 80% to 86% of cases; 48.5% of the cases of perforated ulcer were in shock at the time of admission. The size of perforation is less than 5 mm in 13/81 cases. In only 9/81 cases the size was more than 10 mm, in 59/81 of cases the size was 5 to 10 mm. The site of perforation in 77 cases is on the anterior wall of first part of duodenum, 4 cases showed perforation at pylorus/Gastroduodenal junction. History of taking NSAID is an important aetiological factor in our study, persons having this history showed perforations of related larger size and higher incidence of death. In 96.3% of the cases, the operative procedure adopted is simple closure of the perforation with live omental patch. The longer the time interval between perforation of peptic ulcer and the operation, morbidity and mortality is high. Postoperative complications are seen more in cases with comorbid conditions like Diabetes Mellitus, Hypertension, Old age, Ischaemic heart disease. Average duration of stay in hospital after surgery in this study is 13.4 days. At MGM Hospital, Trichy in 81 cases of Peptic ulcer perforation studied from December 2014 to August 2015, the mortality rate is 13.5%. CONCLUSION Smoking, Alcohol intake, Stress and NSAID intake, Blood group has significant association with peptic ulcer perforation. Out of 81 patients studied, 11 deaths occurred and the mortality rate is 13.5%. Duration between onset of perforation and management is the most significant predictor for mortality. Associated comorbid conditions have significance in secondary outcomes, but does not show significant association to death.
Authors and Affiliations
Yeganathan , Nagarajan , Mahalakshmi , Manimaran , Anandan
Keywords
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- EP ID EP164784
- DOI 10.14260/jemds/2016/883
- Views 55
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