Mortality in perforated duodenal ulcer depends upon pre-operative risk: a retrospective 10-year study.

Hdl Handle:
http://hdl.handle.net/10147/203251
Title:
Mortality in perforated duodenal ulcer depends upon pre-operative risk: a retrospective 10-year study.
Authors:
Larkin, J O; Bourke, M G; Muhammed, A; Waldron, R; Barry, K; Eustace, P W
Affiliation:
Department of Surgery, Mayo General Hospital, Castlebar, Co., Mayo, Ireland., larkin.dundalk@gmail.com
Citation:
Ir J Med Sci. 2010 Dec;179(4):545-9. Epub 2010 Jun 30.
Journal:
Irish journal of medical science
Issue Date:
31-Jan-2012
URI:
http://hdl.handle.net/10147/203251
DOI:
10.1007/s11845-010-0515-1
PubMed ID:
20589448
Abstract:
INTRODUCTION: Most patients presenting with acutely perforated duodenal ulcer undergo operation, but conservative treatment may be indicated when an ulcer has spontaneously sealed with minimal/localised peritoneal irritation or when the patient's premorbid performance status is poor. We retrospectively reviewed our experience with operative and conservative management of perforated duodenal ulcers over a 10-year period and analysed outcome according to American Society of Anesthesiologists (ASA) score. METHODS: The records of all patients presenting with perforated duodenal ulcer to the Department of Surgery, Mayo General Hospital, between January 1998 and December 2007 were reviewed. Age, gender, co-morbidity, ASA-score, clinical presentation, mode of management, operative procedures, morbidity and mortality were considered. RESULTS: Of 76 patients included, 48 (44 operative, 4 conservative) were ASA I-III, with no mortality irrespective of treatment. Amongst 28 patients with ASA-score IV/V, mortality was 54.5% (6/11) following operative management and 52.9% (9/17) with conservative management. CONCLUSION: In patients with a perforated duodenal ulcer and ASA-score I-III, postoperative outcome is uniformly favourable. We recommend these patients have repair with peritoneal lavage performed, routinely followed postoperatively by empirical triple therapy. Given that mortality is equivalent between ASA IV/V patients whether managed operatively or conservatively, we suggest that both management options are equally justifiable.
Language:
eng
MeSH:
Aged; Duodenal Ulcer/complications/*mortality/surgery/*therapy; Female; Humans; Male; Middle Aged; Peptic Ulcer Perforation/*mortality/surgery/*therapy; Peritoneal Lavage; Retrospective Studies; Risk Assessment; Risk Factors; Survival Analysis
ISSN:
1863-4362 (Electronic); 0021-1265 (Linking)

Full metadata record

DC FieldValue Language
dc.contributor.authorLarkin, J Oen_GB
dc.contributor.authorBourke, M Gen_GB
dc.contributor.authorMuhammed, Aen_GB
dc.contributor.authorWaldron, Ren_GB
dc.contributor.authorBarry, Ken_GB
dc.contributor.authorEustace, P Wen_GB
dc.date.accessioned2012-01-31T15:55:29Z-
dc.date.available2012-01-31T15:55:29Z-
dc.date.issued2012-01-31T15:55:29Z-
dc.identifier.citationIr J Med Sci. 2010 Dec;179(4):545-9. Epub 2010 Jun 30.en_GB
dc.identifier.issn1863-4362 (Electronic)en_GB
dc.identifier.issn0021-1265 (Linking)en_GB
dc.identifier.pmid20589448en_GB
dc.identifier.doi10.1007/s11845-010-0515-1en_GB
dc.identifier.urihttp://hdl.handle.net/10147/203251-
dc.description.abstractINTRODUCTION: Most patients presenting with acutely perforated duodenal ulcer undergo operation, but conservative treatment may be indicated when an ulcer has spontaneously sealed with minimal/localised peritoneal irritation or when the patient's premorbid performance status is poor. We retrospectively reviewed our experience with operative and conservative management of perforated duodenal ulcers over a 10-year period and analysed outcome according to American Society of Anesthesiologists (ASA) score. METHODS: The records of all patients presenting with perforated duodenal ulcer to the Department of Surgery, Mayo General Hospital, between January 1998 and December 2007 were reviewed. Age, gender, co-morbidity, ASA-score, clinical presentation, mode of management, operative procedures, morbidity and mortality were considered. RESULTS: Of 76 patients included, 48 (44 operative, 4 conservative) were ASA I-III, with no mortality irrespective of treatment. Amongst 28 patients with ASA-score IV/V, mortality was 54.5% (6/11) following operative management and 52.9% (9/17) with conservative management. CONCLUSION: In patients with a perforated duodenal ulcer and ASA-score I-III, postoperative outcome is uniformly favourable. We recommend these patients have repair with peritoneal lavage performed, routinely followed postoperatively by empirical triple therapy. Given that mortality is equivalent between ASA IV/V patients whether managed operatively or conservatively, we suggest that both management options are equally justifiable.en_GB
dc.language.isoengen_GB
dc.subject.meshAgeden_GB
dc.subject.meshDuodenal Ulcer/complications/*mortality/surgery/*therapyen_GB
dc.subject.meshFemaleen_GB
dc.subject.meshHumansen_GB
dc.subject.meshMaleen_GB
dc.subject.meshMiddle Ageden_GB
dc.subject.meshPeptic Ulcer Perforation/*mortality/surgery/*therapyen_GB
dc.subject.meshPeritoneal Lavageen_GB
dc.subject.meshRetrospective Studiesen_GB
dc.subject.meshRisk Assessmenten_GB
dc.subject.meshRisk Factorsen_GB
dc.subject.meshSurvival Analysisen_GB
dc.titleMortality in perforated duodenal ulcer depends upon pre-operative risk: a retrospective 10-year study.en_GB
dc.contributor.departmentDepartment of Surgery, Mayo General Hospital, Castlebar, Co., Mayo, Ireland., larkin.dundalk@gmail.comen_GB
dc.identifier.journalIrish journal of medical scienceen_GB
dc.description.provinceConnacht-

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