Laparoscopic Repair of Perforated Duodenal Ulcer
Ayman Gehad Hussen Maady;
Abstract
Although there is a decreasing incidence, perforated duodenal ulcer remains a serious condition which generally requires surgical intervention, and is associated with a high mortality rate especially among the elderly. (Saber, 2011)
Evidence now clearly accuses both H. pylori and non-steroidal anti-inflammatory drugs as the primary causes of ulcer perforation.(Sánchez et al., 2011)
The history and physical examination provide essential clues; perforation is largely a clinical diagnosis. (Møller et al., 2010)
Classical picture is sudden onset of severe, diffuse abdominal pain in patient 50-70 years of age, chronically ill, may have a history of peptic ulcer disease, or nonsteroidal anti-inflammatory drugs usage. (Bertleff& Lange.2010)(Møller et al., 2010)
The presence of free air in erect posteroanterior chest radiograph is highly suggestive of perforated duodenal ulcer. (Ferzoco et al. 2013)Gastroduodenogram is likely to detect most macro-leaks. (Ferzoco et al., 2013)
The primary goal of treatment is to save the patient’s life by eliminating the source of infection and cleaning the abdominal cavity. The secondary goal is to cure, if possible, the ulcer diathesis. (Moshe et al., 2010)
There are two main accepted regimen of treatment of duodenal perforation; non-operative (conservative) and surgical treatment. Non-operative treatment is indicated for high-risk patients who would not tolerategeneral anaesthesia, or for patients with a sealed retroperitoneal perforation. (Oida et al., 2012)(Saber, 2011)
Surgery forms the mainstay of treating perforation; it is indicated in patients with hemodynamic instability, signs of peritonitis and free extravasation of contrast on upper gastrointestinal contrast studies.That can be done by laparoscopy or open laparotomy. (Saber, 2011) (Prabhu&Shivani, 2014)
Evidence now clearly accuses both H. pylori and non-steroidal anti-inflammatory drugs as the primary causes of ulcer perforation.(Sánchez et al., 2011)
The history and physical examination provide essential clues; perforation is largely a clinical diagnosis. (Møller et al., 2010)
Classical picture is sudden onset of severe, diffuse abdominal pain in patient 50-70 years of age, chronically ill, may have a history of peptic ulcer disease, or nonsteroidal anti-inflammatory drugs usage. (Bertleff& Lange.2010)(Møller et al., 2010)
The presence of free air in erect posteroanterior chest radiograph is highly suggestive of perforated duodenal ulcer. (Ferzoco et al. 2013)Gastroduodenogram is likely to detect most macro-leaks. (Ferzoco et al., 2013)
The primary goal of treatment is to save the patient’s life by eliminating the source of infection and cleaning the abdominal cavity. The secondary goal is to cure, if possible, the ulcer diathesis. (Moshe et al., 2010)
There are two main accepted regimen of treatment of duodenal perforation; non-operative (conservative) and surgical treatment. Non-operative treatment is indicated for high-risk patients who would not tolerategeneral anaesthesia, or for patients with a sealed retroperitoneal perforation. (Oida et al., 2012)(Saber, 2011)
Surgery forms the mainstay of treating perforation; it is indicated in patients with hemodynamic instability, signs of peritonitis and free extravasation of contrast on upper gastrointestinal contrast studies.That can be done by laparoscopy or open laparotomy. (Saber, 2011) (Prabhu&Shivani, 2014)
Other data
| Title | Laparoscopic Repair of Perforated Duodenal Ulcer | Other Titles | علاج ثقب قرحة الإثني عشر بالمنظار الجراحى | Authors | Ayman Gehad Hussen Maady | Issue Date | 2014 |
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