Mortality in perforated duodenal ulcer depends upon pre-operative risk: a retrospective 10-year study.
AffiliationDepartment of Surgery, Mayo General Hospital, Castlebar, Co., Mayo, Ireland., firstname.lastname@example.org
Peptic Ulcer Perforation/*mortality/surgery/*therapy
MetadataShow full item record
CitationIr J Med Sci. 2010 Dec;179(4):545-9. Epub 2010 Jun 30.
JournalIrish journal of medical science
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.
- Morbidity and mortality of perforated peptic gastroduodenal ulcer following emergency surgery.
- Authors: Kujath P, Schwandner O, Bruch HP
- Issue date: 2002 Nov
- [Perforated peptic ulcer--a 12-year material].
- Authors: Forsmo HM, Glomsaker T, Vandvik PO
- Issue date: 2005 Jun 30
- Conservative management of perforated peptic ulcer.
- Issue date: 1989 Dec 16
- What is the best predictor of mortality in perforated peptic ulcer disease? A population-based, multivariable regression analysis including three clinical scoring systems.
- Authors: Thorsen K, Søreide JA, Søreide K
- Issue date: 2014 Jul
- [Perforation of gastroduodenal ulcer: a risk analysis].
- Authors: Walgenbach S, Bernhard G, Dürr HR, Weis C
- Issue date: 1992 Aug 15