Abstract
Background – Conservative treatment of perforated peptic ulcer has documented good results in carefully selected patients with fair general condition. The aim of this study is to determine whether surgery could be avoided in some selected patients with peptic ulcer perforation.
Material and Methods – during the period July 2002-Nov 2012, 68 patients who were treated conservatively forms the study population. Conservative treatment consists of nasogastric aspiration, keeping patient nil per orally, administration of IV antibiotics, fluid supplements, proton pump inhibitor and close monitoring of vital signs and abdominal girth.
Endpoints – Duration of hospital stay
Results –Most of the patients in our study were in age group of 40-70 years (63.24%) with male: female ratio of 38:5.We also noticed that 50 % of patients came to the hospital within 24 hours of onset of symptoms. Median hospital stay was 8.48 days. We had no mortality during our study or follow up period.
Conclusion – Conservative management of peptic ulcer perforation is a safe procedure in selected cases particularly in medically unfit patients for surgery but care should be taken for the possibility of laparotomy anytime.
Key Words – Peptic ulcer, Peptic ulcer perforation, Surgical repair, Conservative management.
References
1. Paimela H, Paimela L, Myllykangas-luosujarvi R, et al. Current features of peptic ulcer disease in Finland: incidence of surgery, hospital admissions and mortality for the disease during the past twenty-five years. Scand J Gastroenterol. 2002;37:399–403.
2. Paimela H, Oksala N, Kivilaakso E. Surgery for peptic ulcer today. A study on the incidence, methods and mortality in surgery for peptic ulcer in Finland between 1987 and 1999. Dig Surg. 2004;21:185–91.
3. Higham J, Kang J, Majeed A. Recent trends in admissions and mortality due to peptic ulcer in England: increasing frequency othaemorrhage among older subjects. Gut. 2002;50:460–4.
4. Gisbert J, Legido J, Garcia-Sanz I, et al. Helicobacter pylori and perforated peptic ulcer: prevalence of the infection and role of non-steroidal anti-inflammatory drugs. Dig Liver Dis. 2004;36:116–20.
5. Lau H. Laparoscopic repair of perforated peptic ulcer: a metaanalysis. Surg Endosc. 2004;18:1013–21.
6. Siu W, Chau C, Law B, et al. Routine use of laparoscopic repair for perforated peptic ulcer. Br J Surg. 2004;91:481–4.
7. Siu W, Leong H, Law B, et al. Laparoscopic repair for perforated peptic ulcer: a randomized controlled trial. Ann Surg. 2002;235:313–9.
8. Tsumura H, Ichikawa T, Hiyama E, et al. Laparoscopic and open approach in perforated peptic ulcer. Hepatogastroen-terology. 2004;51:1536–9.
9. Crofts TJ, Kenneth GM, Park MB, Steele RJC, Chung SSC, Li AKC. A randomized trial of nonoperative treatment for perforated duodenal ulcer. N Engl J Med 1989;320:970-3.
10. Donovan AJ, Vinson TL, Maulsby GO, Gewin JR. Selective treatment of duodenal ulcer with perforation. Ann Surg 1979; 189:627-36.
11. Taylor H, Warren RP. Perforated acute and chronic peptic ulcer. Conservative treatment. Lancet 1956; i: 397-9.
12. Songne B, Jean F, Foulatier O, et al. Traitement non opératoire des perforations d’ulcèregastroduodénal. Résultatsd’une etude prospective. Ann Chir. 2004;129: 578–82.
13. Crofts T, Park K, Steele R, et al. A randomized trial of nonoperative treatment for perforated peptic ulcer. N Engl J Med. 1989;320:970–3.
14. Giacchi R, Fattori A, De Poda D, et al. A conservative Taylor’s method in the treatment of peptic perforation.G Chir. 1990;11: 640–2.
15. Staed J. Conservative treatment of perfo-rated peptic ulcer. Lancet. 1951;1:12–7.
16. Donovan A, Berne T, Donovan J. Perforated duodenal ulcer: an alternative therapeutic plan. Arch Surg. 1998;133: 1166–71.
17. Steeley S, Campbell D. Nonoperative treatment of perforated duodenal ulcer: a further report. Surg Gynecol Obstet. 1956;102: 435–46.
18. Leconte D, Hiebel G. La méthode de Taylor dans le traitement des ulcères gastro-duodenauxperforés: est-ellevraim-entdésuète? Ann GastroenterolHepatol. 1986;22:261–6.
19. Bugnon P, Rivoalan F, Gautier-Benoit C. Present status of the Taylor method in perforated ulcer of the duodenal bulb. J Chir. 1986;123:463–6.
20. Keane T, Dillon B, Afdhal N, et al. Conservative management of perforated duodenal ulcer. Br J Surg. 1988;75:583–4.
21. Berne T, Donovan A. Non-operative treatment of perforated duodenal ulcer. Arch Surg 1989;124:830–2.
22. Irvin T. Mortality and perforated peptic ulcer: case for risk stratification in elderly patients. Br J Surg 1989;76:215-8.
23. Ball AB, Thomas PA, Evans SJ. Operative mortality after perforated peptic ulcer. Br J Surg 1989;76:521-2.
24. Crofts TJ, Park KGM, Steele RJC, Li AKC. A randomized trial of non-operative treatment for perforated peptic ulcer. N Engl J Med 1989; 320: 970-3.
25. Berne CJ, Rosoff L Sr. Acute perforation of peptic ulcer. In: Nyhus LN, Wastell O, editors. Surgery of the stomach and duodenum. Boston, Mass: Little Brown & Co Inc; 1986: 45773.