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Changing Trends in Perforative Peritonitis-Rural Hospital Based Study

Kirthana B., Post Graduate, Department of General Surgery, MVJ Medical College & Research Hospital (MVJMC & RH), Hoskote, Karnataka 562114, India. , Ananth Kumar N.1 , Kirthana B.2

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New Indian Journal of Surgery 9(5):p 574-578, Sep-Oct 2018. | DOI: DOI: https://dx.doi.org/10.21088/nijs.0976.4747.9518.6

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Abstract

Peptic ulcer disease causes high morbidity worldwide anually. The incidence of PUD has been estimated at around 1.5% to 3%. High risk of morbidity  and mortality are found in patients with perforated peptic ulcer. PPU carries a high risk of motality.perforation is the major complication and treating them is most challenging. Perforation is the most disastrous complication of peptic ulcer and in spite of modern management it is still life threatening catastrophe (Hugh TB, 1990). The mainstay of treatment for bowel perforation is repair of perforation-surgically, Endoscopic, Laparoscopic procedures are now being increasingly performed instead of conventional laparotomy. The most common emergency in india compared to western world is peritonitis caused due to perforation. Materials and Methods: This study has been based on the analysis of 75 cases of hollow viscous perforation admitted to MVJ Medical College & Research Hospital. Duration of study was from AUG 2016 to MARCH 2017 (9 months) Type of study: Prospective study. Study was conducted after obtaining ethical clearance from ethics committee. Out of the 75 cases of peritonitis secondary to hollow viscus perforation all underwent emergency laparotomy and the site of perforation, its pathological condition, post operative complications , mortality were studied. Medical management can be attempted in peptic ulcer disease.perforation remains as the important complication in treating the peptic ucer.perforated oeptic ulcer presents with abdominal pain gyuarding and  tachycardia. Erect chest radiograph may not establish the diagnosis and an index of suspicion is essential. Early diagnosis, prompt resuscitation and urgent surgical intervention are essential to improveoutcomes. Non-operative management should be conducted by experienced teams with optimal resources and ideally under trial conditions. Exploratory laparotomy and grams omental patch stills remains as the gold standard. Gastrectomy is  recommended in patients with large  or malignant ulcer to enhance outcomes; however the outcomes of patients treated with gastric resections remain inferior. Gelatin sponge plugs, fibrin glue sealants, selfexpandable stents and endoscopic clipping techniques are the newer advancements. Results: Duodenal to gastric ulcer perforation ratio when we compare to western population it stands out at 4:1 and in Indian population it is 30:1. In our study, interestingly for every 4 duodenal ulcer perforations there were 2.5 gastric ulcer perforations. This indicates the changing ratio of duodenal to gastric ulcer perforation approximately 2:1. Conclusion: Peptic ulcer can now be treated with medications instead of elective surgery. However, ulcer may perforate and carries a high mortality risk. There is a changing trend of increasing perforated gastric ulcer, but still duodenal ulcer perforation remains most common cause of peritonitis. Early diagnosis, prompt resuscitation and urgent surgical intervention are essential to improve outcomes.

Keywords: Perforative Peritonitis; Peptic ulcer; Gastrectomy.   

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DOI: DOI: https://dx.doi.org/10.21088/nijs.0976.4747.9518.6

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