CLINICO-PATHOLOGICAL STUDY AND MANAGEMENT OF DUODENAL ULCER PERFORATION
Journal Title: Journal of Evolution of Medical and Dental Sciences - Year 2013, Vol 2, Issue 34
Abstract
[b] NEED FOR STUDY[/b]: Acute perforation of the duodenal ulcer produces one of the most dramatic pictures of acute abdominal catastrophe. The classical board like rigidity and its associated life threatening complications are quite striking in most cases. Smoking and alcohol are known co morbid factor known to be associated with duodenal ulcer perforation. The mean prevalence of H. Pylori infection in patients with perforated duodenal ulcer is 60% as compared with 90%-100% in uncomplicated ulcer. Collier and Pain speculated that the elderly, taking NSAIDS are particularly susceptible to the development of perforated duodenal ulcer. The perforated viscous challenges the surgeons skill as a technician and his knowledge of pre operative , intra operative , care of severely ill patients. Majority of patient with sudden onset of abdominal pain a high index of suspicion is essential to diagnose hollow viscous perforation early, as significant mortality and morbidity result from diagnostic delay. Factors such as concomitant disease, shock on admission, delayed surgery (more than 24 hours), post operative abdominal and wound infection have been associated with increased morbidity and mortality in ulcer patients. In spite of better understanding of disease, effective resuscitation and prompt surgery under modern anesthesia techniques, there is high morbidity and mortality. Hence, attempt has been made to analyze the various factors that are affecting the morbidity and mortality of patients with duodenal ulcer perforation. [b]METHODS[/b]: The study population consisted of patients who are admitted with duodenal ulcer perforation, which was clinically diagnosed and supported by radiological examination and sonological examination. A proforma drafted for study of these patients was used. Patient was examined systematically giving importance to clinical examination. A treatment was instituted appropriately and follow up done. [b]RESULTS[/b]: Most of the cases were due to perforation of duodenal ulcer in the anterior wall of first part of the duodenum. Most patients who presented early had good recovery with minimal post operative complications. Patients who presented late more than 48 hours after perforation had high post operative complications and high mortality rate. Recovery of the patient also depends on the size of perforation, more the size of the perforation more the chances of presenting with leak and more complications. H. Pylori is a major risk factor for duodenal perforation. Perforation is more common in patients with history of smoking and alcoholism. I[b]NTERPRETATION AND CONCLUSION[/b]: Duodenal ulcer perforation is quite common among the patients with peptic ulcer disease with history of chronic smoking and alcoholism, commonly in males. Large group has delayed presentation, which has significant impact on the increased mortality and morbidity of the patient. Poor condition of the patient at the time of the admission worse is the prognosis. Diagnosis is mainly by the clinical examination and confirmation by x ray examination. Main treatment done is simple closure of perforation with peritoneal lavage. Early diagnosis and prompt management of shock and septicemia is important for better prognosis of patients.
Authors and Affiliations
Sreenidhi G. M, Nandeeshkumar G. N
Keywords
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