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Peptic Ulcer Disease: Perforation

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General Surgery

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Pearls and Pitfalls

  • The epidemiology of peptic ulcer disease has changed dramatically.

  • The medical management of symptomatic peptic ulcer disease has improved.

  • There has been no decrease in ulcer perforations over the last decades.

  • Two main trends responsible for the unchanged rate of complications (perforation, bleeding)

    • Decrease in prevalence of Helicobacter pylori

    • Increase in use of NSAIDs

  • Ulcer perforations occur mostly in stomach (60%) or duodenum (40%)

  • One third to one half of ulcer perforations are associated with NSAID use

  • Clinical presentation tends to occur in 3 phases

    • Phase one: 0–2 h after onset, Initial sudden onset of severe abdominal pain

    • Phase two: 2–12 h after onset, Less abdominal pain

    • Phase three: >12 h after onset, Increasing abdominal extension

  • Rapid diagnosis is essential!

  • Perforation is largely a clinical diagnosis: abdominal rigidity

  • Abdominal x-ray: look for free air; no further examination necessary: this is an indication for surgical exploration

    ...

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Selected Readings

  • Bloom BS, Kroch E (1993) Time trends in peptic ulcer disease and in gastritis and in duodenitis: mortality, utilization and disability in the United States. J Clin Gastoenterol 17:33–342

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  • Crofts TJ, Park KG, Steele RJ, et al. (1989) A randomized trial of non operative treatment for perforated peptic ulcer. N Engl J Med 320:970

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  • El-Serag HB, Sonnenberg A (1998) Opposing time trends of peptic ulcer and reflux disease. Gut 43:327–33

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  • Gunshefski L, Flancbaum L, Brolin RE, Frankel A (1990) Changing patterns in perforated peptic ulcer disease. Am Surg 56:270

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  • Katkhouda N, Mavor E, Mason RJ, et al. (1999) Laparoscopic repair of perforated duodenal ulcers: outcome and efficacy in 30 consecutive patients. Arch Surg 134:845–848

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  • Ng EK, Lam YH, Sung JJ (2000) Eradication of Helicobacter pylori prevents recurrence of ulcer after simple closure of duodenal ulcer perforation: randomized controlled trial. Ann Surg 231:153–158

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  • Silen W (1996) Cope's early diagnosis of the acute abdomen. Oxford University Press, New York

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Authors
  1. Anja Schaible
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  2. Peter Kienle
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Editor information

Editors and Affiliations

  1. Department of Surgery, Deputy Director, Comprehensive Cancer Center University of Alabama School of Medicine, Birmingham, AL, USA

    Kirby I. Bland MD (Fay Fletcher Kerner Professor and Chairman) (Fay Fletcher Kerner Professor and Chairman)

  2. Department of General and Visceral Surgery, University of Heidelberg, Heidelberg, Germany

    Markus W. Büchler MD (Professor of Surgery and Chairman) (Professor of Surgery and Chairman)

  3. Department of Surgery, University Hospital, Santiago, Chile

    Attila Csendes MD, FACS (Hon) (Professor of Surgery and Chairman) (Professor of Surgery and Chairman)

  4. James C. Mason Professor of Surgery Department of Surgery, Mayo Clinic College of Medicine, Rochester, MN, USA

    Michael G. Sarr MD

  5. Department of Clinical and Surgical Sciences, The University of Edinburgh Royal Infirmary of Edinburgh, Edinburgh, UK

    O. James Garden MBChB, MD, FRCS (Ed), FRCP (Ed), FRACS (Hon) (Regius Professor of Clinical Surgery) (Regius Professor of Clinical Surgery)

  6. Department of Surgery, The University of Hong Kong Queen Mary Hospital, Hong Kong, China

    John Wong BSc (Med (Syd)), MBBS (Syd), PhD (Syd), MD (Hon (Syd)), FRACS, FRCS (Edin), FRCS (Glasg), FACS (Hon) (Chair Professor) (Chair Professor)

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© 2009 Springer Science+Business Media, LLC

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Schaible, A., Kienle, P. (2009). Peptic Ulcer Disease: Perforation. In: Bland, K.I., Büchler, M.W., Csendes, A., Sarr, M.G., Garden, O.J., Wong, J. (eds) General Surgery. Springer, London. https://doi.org/10.1007/978-1-84628-833-3_48

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  • DOI: https://doi.org/10.1007/978-1-84628-833-3_48

  • Publisher Name: Springer, London

  • Print ISBN: 978-1-84628-832-6

  • Online ISBN: 978-1-84628-833-3

  • eBook Packages: MedicineReference Module Medicine

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