High prevalence of helicobacter pylori infection in duodenal ulcer perforations not caused by non. T ension pneumoperitoneum tpp, also known as hyperacute abdominal compartment syndrome or abdominal tamponade, is a rare condition most commonly associated with gastrointestinal gi perforation during endoscopy and iatrogenic insufflation of gas into the peritoneal cavity. Perforated pyloroduodenal peptic ulcer and sonography. The interval between the perforation and the operation is of great significance. Surgical abdominal exploration both laparoscopic and laparotomic is always indicated in gastroduodenal perforation. Very little data is available in literature regarding the definition, incidence, and the management of large perforations of duodenal ulcers. Duodenal perforation after endoscopic procedure federal. Results of conservative treatment for perforated gastroduodenal ulcer in patients not eligible for surgical repair. Synchronous perforation of a duodenal and gastric ulcer. Localized or generalized peritonitis is typical of perforated peptic ulcer, but may be present in only twothirds of the patients 14,15,16. You can get an ulcer in your stomach as well as in your duodenum. Management of perforated gastroduodenal ulcer gdu is not consensual, from no operative treatment to surgery by simple closure, gastrectomy and vagotomy. The pyloric thickening seen on ct was due to edema in the wall. Therapeutic management of perforated gastroduodenal ulcer.
The management of large perforations of duodenal ulcers. Patient was taken for laparotomy, duodenal perforation was sealed with om. Case report jeiunal patch repair of a duodenal perforation 0 a kalyani, mbbs, emteoh, ms gen surgery, n sukumar, ms gensurgery department ofsurgery, university kebangsaan malaysia, jalan yaacob latiff, bandar tun razak, 56000, kuala lumpur. Mdct identified pneumoperitoneum in 15 of 15 cases as compared with three of nine cases for plain films. It usually remains for five to seven days and heals within two weeks with no scarring. Overall crude incidence of gastroduodenal perforations in ubth was 21. This paper represents our experience with the management of this subset of duodenal ulcer perforations over a period of three years from january 2001 to december 2003. Acute perforation of a duodenal ulcer is a calamity that demands prompt surgical treatment. Identifier les situations durgence et planifier leur prise en charge. A few perforations however result in lifethreatening retroperitoneal necrosis and require surgical. Rochester, new york in 1880 miculicz performed what was probably the first surgical closure of a perforated peptic ulcer.
A read is counted each time someone views a publication summary such as the title, abstract, and list of authors, clicks on a figure, or views or downloads the fulltext. Gastroduodenal ulcer definition of gastroduodenal ulcer. Most are minor perforations that settle with conservative management. If you do not see its contents the file may be temporarily unavailable at the journal website or you do not have a pdf plugin installed and enabled in your browser. San francisco, california this study was undertaken in order to evaluate properly the results of surgical treatment of acute perforated ulcers of the stomach and duodenum at. Ng et al reported 80% 58 of 73 case of pdu were infected. Perforated peptic ulcer is a common emergency condition worldwide, with associated mortality rates of up to 30%. Gastroduodenal peptic ulcer perforation how is gastroduodenal peptic ulcer perforation abbreviated. An ulcer in the stomach is called a gastric ulcer, while one in the first part of the intestines is a duodenal ulcer.
Peritonitis due to peptic ulcer perforation is a surgical emergency with a high risk of mortality and morbidity. A free powerpoint ppt presentation displayed as a flash slide show on id. Anatomy arterial blood supply left gastric artery right gastric artery right gastroepiploic artery from gastroduodenal artery left gastroepiploic artery a branch of splenic artery. We present a rare case of a 54yearold caucasian man who underwent an emergency laparotomy for peritonitis caused by perforation of two peptic ulcers.
Surgical management of duodenal perforations after ercp. Alternatively, you can download the file locally and open with any standalone pdf reader. Some underlying causes of gastroduodenal perforation have been reported but remain largely. Management of acute duodenal peptic perforations request pdf. Iatrogenic injury is an increasing cause of gastroduodenal perforation. The first was located on the anterior wall of the duodenum and the second was posterior, prepyloric, close to the lesser.
The responsibility of the physician who first sees a patient following perforation is grave. H pylori plays a central role high % of h pylori infections reported with perforated duodenal ulcers. Perforation of 1st part of duodenum was confirmed on endoscopy. In gastroduodenal perforation the peritoneal cavity. Perforation occurs in about 5% to 10% of patients with active ulcer disease. Check the full list of possible causes and conditions now.
We report three cases, all with other features typical of nonaccidental injury. A therapeutic alternative for perforated gastroduodenal ulcer in the context of actual trends towards an efficient and less aggressive therapy of peptic ulcer, it. Diagnosis and treatment of perforated or bleeding peptic. Clinical and radiographic features can be used to determine which type of surgical or conservative treatment of ercprelated duodenal perforations, whereas intraoperative findings can determine the final outcome and morbidity or mortality. Duodenal, antral and gastric body ulcers account for 60%, 20% and 20% of perforations, respectively, of peptic ulcers 4,5. The concept of gastroduodenal mucosal injury has evolved from the notion of topical injury to concepts that involve multiple mechanisms. Your duodenum is the first part of your small intestine, the part of your digestive system that food travels through straight after it leaves your stomach. Acute perforated gastroduodenal ulcer sciencedirect. Gastroduodenal perforation has also been reported as a complication of a variety of abdominal procedures including inferior vena cava filter placement 17, 18, ercp 19, 20, and biliary. Bucher p, oulbaci w, morel p, ris f, huber o 2007 results of conservative treatment for perforated gastroduodenal ulcer in patients not eligible for surgical repair.
Diagnostic delay is common, as the true history is concealed and signs may be minimal. Nobuaki doi 1, kazuhito miyachi 1, yasuhiro nozaki 1, ryuji hashimoto 1, munenori azuma 1, mitsuo nanba 1, syoichi ikeguchi 1, shigemitsu shida 1. The purpose of this study is to report results of the literature concerning management of perforated gdu. A scarcity of highquality studies about the condition limits the knowledge base for clinical decision making, but a few. In the period 19782004, 533 patients were admitted for perforated gastroduodenal ulcer. Gastroduodenal definition of gastroduodenal by medical. Showed an increase in the wall thickness of the antrum and duodenum of first portion with free fluid paraduedenal.
Thus, physical examination findings may be equivocal and peritonitis may be minimal or absent, particularly in patients with contained and sealed leak. The most common symptoms of a duodenal ulcer are waking at night with upper abdominal pain and upper abdominal pain that improves. About a retrospective study from january 1st 2006 to march 31st, 2012 in visceral surgery at cnhu of cotonou, records of 86 cases of duodenal or gastric ulcer perforation were analyzed. The increasing use of esophagoduodenoscopy for diagnosis and therapy is associated with an increase in procedurerelated perforations. Double contrast computed tomography is the most sensitive investigation to confirm clinical suspicion.
For this reason surgeons have shown it the greatest consideration. The purpose of this article is to illustrate the spectrum of sonographic findings in perforated pyloroduodenal peptic ulcer and discuss the potential role of sonography in the diagnosis. A duodenal ulcer is a sore that forms in the lining of the duodenum. Gastroduodenal peptic ulcer perforation listed as gpup. European scientific journal september 2016 edition vol. Non operative management of perforated duodenal ulcers. The clinical presentation of gastroduodenal perforation is usually sudden onset of abdominal pain.