Journal of Emergencies, Trauma, and Shock
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LETTER TO EDITOR  
Year : 2013  |  Volume : 6  |  Issue : 1  |  Page : 61
Perforated peptic ulcer: Determinants of outcome and mortality


Departments of General Surgery and Acute Care Surgery, Rambam Health Care Campus, Haifa, Israel

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Date of Web Publication22-Jan-2013
 

How to cite this article:
Ben-Ishay O, Bahouth H, Kluger Y. Perforated peptic ulcer: Determinants of outcome and mortality. J Emerg Trauma Shock 2013;6:61

How to cite this URL:
Ben-Ishay O, Bahouth H, Kluger Y. Perforated peptic ulcer: Determinants of outcome and mortality. J Emerg Trauma Shock [serial online] 2013 [cited 2020 Sep 19];6:61. Available from: http://www.onlinejets.org/text.asp?2013/6/1/61/106330


Sir,

Elective surgery for the management of peptic ulcer disease (PUD) has decreased significantly, but emergency surgical interventions for its complications are still common. [1],[2] The objective of our study was to identify variables that are associated with the outcome and mortality of this life-threatening condition.

Charts of patients operated for perforated ulcer in our department over 9 years were reviewed retrospectively. Forty-one patients were operated for perforated PUD. Overall mortality was 27%, mean age of the deceased was 75 vs 51 in the survivors (P < 0.001). Among the survivors, mean age of men was, significantly younger than women (46.4 vs 60.2; P = 0.007). Blood lactate levels were significantly higher in the deceased (5 vs. 2.2 mg/dl, P = 0.019), urinary amylase was significantly higher in the surviving patients (184.7 vs. 1538.31 mg/dl; P = 0.007), other variables were similar in both groups. Diabetes mellitus influence patient's outcome while history of PUD, smoking and the use of NSAIDs did not prove to do so. All variables were compared between patients younger and older than 60 years old. Younger males suffer more perforation (P = 0.0001) and suffer more of PUD prior to perforation. Perforation to operation interval is significantly longer (P = 0.03) in the older patients mostly due to delay in presentation to the hospital.

In conclusion our study shows that in perforated PUD, older age, elevated lactate levels and diabetes might predict an unfavorable outcome even among patients operated in a timely manner. Age is a primary independent risk factor for mortality in patients with perforated PUD. Younger patient suffer more of PUD preoperatively and perforation to operation interval in the older patients was significantly longer.

 
   References Top

1.Forbes GM, Glaser ME, Cullen DJ, Warren JR, Christiansen KJ, Marshall BJ, et al. Duodenal ulcer treated with Helicobacter pylori eradication: Seven-year follow-up. Lancet 1994;343:258-60.  Back to cited text no. 1
[PUBMED]    
2.Matsuda M, Nishiyama M, Hanai T, Saeki S, Watanabe T. Laparoscopic omental patch repair for perforated peptic ulcer. Ann Surg 1995;221:236- 40.  Back to cited text no. 2
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Correspondence Address:
Offir Ben-Ishay
Departments of General Surgery and Acute Care Surgery, Rambam Health Care Campus, Haifa
Israel
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0974-2700.106330

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