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Non Operative Management of Sealed Off Peptic Ulcer Perforation: A Clnical Study at a Rural Institute

Anirudh Suseel N., PG Resident, Department of General Surgery, P.E.S. Institute of Medical Sciences and Research, Kuppam, Andhra Pradesh 517425, India. , Balachandar M.1 , Anirudh Suseel N.2

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New Indian Journal of Surgery 9(4):p 446-449, July - August 2018. | DOI: DOI:https://dx.doi.org/10.21088/nijs.0976.4747.9418.9

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Abstract

The most common cause of Peptic ulcer perforation is ulcer disease. In a perforation (1) which appears to have sealed itself already, as shown by diminished pain and improved abdominal signs. (2) Heart or lung disease, which increases the surgical and anaesthetic risks. (3) The patient who is admitted after a day or two and is almost moribund with diffuse peritonitis, non­operative treatment may be best. We undertook a prospective study in the Department of General Surgery at PESIMSR, Kuppam in the period between September 2017 to May 2018 over a period of 9 months with a study population of 20 patients, to evaluate the results and to assess the feasibility of a non­operative treatment for sealed off perforated peptic ulcers.  All were treated conservatively with Herman-Taylor regime i.e, NPO, RT drainage, IV Fluids, IV antibiotics (Changed as per peritoneal tap culture), PPIs and Parenteral nutrition. Flank drains were placed if necessary. Once allowed orally after few days (>48hrs) patients were started on HP kit (for 14 days), multivitamins, high protein diet and good hydration. All 20 patients successfully recovered and thus we conclude the importance of conservative management in sealed off peptic ulcer perforations and thus reducing the mortality, morbidity and monetary burden associated with surgical management.

Keywords: Ulcer; Peptic ulcer; Perforations.

 

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DOI: DOI:https://dx.doi.org/10.21088/nijs.0976.4747.9418.9

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