Peptic Ulcer Perforation Case Study

ABSTRACT

Objective: As the peptic ulcer affects 2-10% of the population and is gradually affecting more of the young as compared to the old so a study was designed to identify the factors associated and look for the complications and incidence of peptic ulcer perforation in young adults. Methods: Patients of either sex between 18-30 years of age diagnosed of peptic ulcer perforation (gastric or duodenal ulcer perforation) failing to respond to medical therapy, admitted on an emergency basis were included into the study. Intra-operative findings pertaining to exploration under general anesthesia, release of free gas as the abdomen was opened, site and size of perforation, amount and nature of peritoneal contamination present were made note

(1-3)

The disease demands prompt diagnosis, timely resuscitation and proper surgical management so as to reduce the morbidity and mortality. Surgery is the mainstay of emergency treatment of these life-threatening complications that are refractory to medical management. The ideal treatment for the perforation of duodenal ulcer has not yet been established. (4-5)

Duodenal perforation is a very common and fatal complication in patients of chronic peptic ulcer symptoms with inadequate or no medical treatment. Perforated duodenal ulcer is mainly a disease of young men but owing to increased smoking and drinking habits in women, NSAID abuse in all the age groups and work related stress, from past few decades peptic ulcer is commonly reported in all adult young population. Up to 80% of patients with perforated duodenal ulcers are Helicobacter pylori positive.

DISCUSSION

Peptic ulcer perforation is the commonest perforation of the gastrointestinal tract that demands prompt diagnosis, timely resuscitation and proper surgical management so as to reduce the morbidity and mortality. Surgery is the mainstay of emergency treatment.

In a study conducted by Bharti et al (1996) on peptic ulcer perforation, group of patients falling between 31-40 years of age had a maximum incidence of peptic ulcer perforation i.e. 48%. Of these, 72% patients had duodenal perforation. 84% patients had a positive X-ray finding and 94% were positive on ultrasound examination (1).

Hannan et al (2005) in their study of peptic perforation also reported highest incidence of 34% in the age group of 30-40 years. The mean age of the patients was 41 years (2).

Duodenal perforation is a very common and fatal complication in patients of chronic peptic ulcer symptoms with inadequate or no medical treatment.

Different from the above two studies, Elnagib et al (2008) reported the maximum incidence of peptic ulcer perforation i.e. 38% in still younger patients of age group of 20-30 years. NSAIDs abuse is amongst an important causative factor for perforation accounting for a total of 43% patients with stress and alcoholism together accounting for 23%