LAPAROSCOPIC MANGEMENT OF PERFORATED DUODENAL ULCER
Eman Mohamed Abdelaziz Aboelalaa;
Abstract
P
erforated duodenl ulcer (PPU) is the most common indication for emergency gastric operation. Perforation occurs in about 2-10% of peptic ulcers and of these about 60% are duodenal. The original of PPU seem to be multifactorial, but most are associated with nonsteroidal anti-inflammatory drugs (NSADS) and Helicobacter pylori (HP) infection. The vast majority of PPU patients require emergency operation.
Promot diagnosis of gastroduodenal perforation requires a high index of suspicion based on history and clinical examination. Patients with gastroduodenal perforation usually present with abdominal pain and peritoneal irritation from leakage of acidic gastric contents. At physical examination pulse might be quickened, but seldom goes beyond 90 beats per minute. About 5-10% of patients experience shock with a mean arterial pressure of less than 80 mmHg. Hypotension is a late finding as is high fever.
Imaging choice for diagnosing bowel perforations include plain films and computed tomography. An upright chest x-ray is an excellent first choice. A positive upright chest x-ray (free air beanth the diaphragm) can acutely make the diagnosis. Laboratory studies are not useful in that acute setting as they tend to be nonspecific, but leukocytosis, metabolic acidosis, and elevated serum amylase may be associated with perforation.
Perforated peptic ulcer can be treated by using a wide range of options, which varies from conservative non-operative treatment to imediate defintive ulcer surgery. Some patients with perforated ulcer can be managed successfully by non-operative means. However, in many cases the uncertainty of the exact underlying pathology and diagnosis can determined from this line of management.
Acid reduction surgery is now being replaced by simpler procedures, such as primary closure of the perforation, owing to better understanding of the pathophysiology of peptic ulcer diseases and the improvement in anti-ulcer medications Simple closure remains an attractive for perforated duodenal ulcer in most centers and hence that laparoscope is gradually gaining popularity to treat perforated duodenal ulcer.
erforated duodenl ulcer (PPU) is the most common indication for emergency gastric operation. Perforation occurs in about 2-10% of peptic ulcers and of these about 60% are duodenal. The original of PPU seem to be multifactorial, but most are associated with nonsteroidal anti-inflammatory drugs (NSADS) and Helicobacter pylori (HP) infection. The vast majority of PPU patients require emergency operation.
Promot diagnosis of gastroduodenal perforation requires a high index of suspicion based on history and clinical examination. Patients with gastroduodenal perforation usually present with abdominal pain and peritoneal irritation from leakage of acidic gastric contents. At physical examination pulse might be quickened, but seldom goes beyond 90 beats per minute. About 5-10% of patients experience shock with a mean arterial pressure of less than 80 mmHg. Hypotension is a late finding as is high fever.
Imaging choice for diagnosing bowel perforations include plain films and computed tomography. An upright chest x-ray is an excellent first choice. A positive upright chest x-ray (free air beanth the diaphragm) can acutely make the diagnosis. Laboratory studies are not useful in that acute setting as they tend to be nonspecific, but leukocytosis, metabolic acidosis, and elevated serum amylase may be associated with perforation.
Perforated peptic ulcer can be treated by using a wide range of options, which varies from conservative non-operative treatment to imediate defintive ulcer surgery. Some patients with perforated ulcer can be managed successfully by non-operative means. However, in many cases the uncertainty of the exact underlying pathology and diagnosis can determined from this line of management.
Acid reduction surgery is now being replaced by simpler procedures, such as primary closure of the perforation, owing to better understanding of the pathophysiology of peptic ulcer diseases and the improvement in anti-ulcer medications Simple closure remains an attractive for perforated duodenal ulcer in most centers and hence that laparoscope is gradually gaining popularity to treat perforated duodenal ulcer.
Other data
| Title | LAPAROSCOPIC MANGEMENT OF PERFORATED DUODENAL ULCER | Other Titles | علاج قرحة الاثنى عشر المثقوبة عن طريق المنظار | Authors | Eman Mohamed Abdelaziz Aboelalaa | Issue Date | 2014 |
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