No abstract available.
Adolescent ; Emphysema/etiology* ; Face ; Human ; Male ; Mediastinal Emphysema/etiology ; Neck ; Peptic Ulcer Perforation/complications* ; Pneumoperitoneum/etiology ; Stomach Ulcer/complications*

PURPOSE: Emergency operations for perforated peptic ulcer are associated with a high incidence of postoperative complications. While several studies have investigated the impact of perioperative risk factors and underlying diseases on the postoperative morbidity after abdominal surgery, only a few have analyzed their role in perforated peptic ulcer disease. The purpose of this study was to determine any possible associations between postoperative morbidity and comorbid disease or perioperative risk factors in perforated peptic ulcer. MATERIALS AND METHODS: In total, 142 consecutive patients, who underwent surgery for perforated peptic ulcer, at a single institution, between January 2005 and October 2010 were included in this study. The clinical data concerning the patient characteristics, operative methods, and complications were collected retrospectively. RESULTS: The postoperative morbidity rate associated with perforated peptic ulcer operations was 36.6% (52/142). Univariate analysis revealed that a long operating time, the open surgical method, age (> or =60), sex (female), high American Society of Anesthesiologists (ASA) score and presence of preoperative shock were significant perioperative risk factors for postoperative morbidity. Significant comorbid risk factors included hypertension, diabetes mellitus and pulmonary disease. Multivariate analysis revealed a long operating time, the open surgical method, high ASA score and the presence of preoperative shock were all independent risk factors for the postoperative morbidity in perforated peptic ulcer. CONCLUSIONS: A high ASA score, preoperative shock, open surgery and long operating time of more than 150 minutes are high risk factors for morbidity. However, there is no association between postoperative morbidity and comorbid disease in patients with a perforated peptic ulcer.
Diabetes Mellitus ; Emergencies ; Health Status Indicators ; Humans ; Hypertension ; Incidence ; Lung Diseases ; Multivariate Analysis ; Peptic Ulcer ; Peptic Ulcer Perforation ; Postoperative Complications ; Risk Factors ; Shock ; Shock, Septic

Behcet's disease (BD) has been recognized as multi-systemic chronic vasculitic disorder of recurrent inflammation, characterized by the involvement of multiple organs and resulting in orogenital ulcers, uveitis, and skin lesions. Involvement of the central nervous system, vessels, and intestines in BD often leads to a poor prognosis. Digestive manifestations in BD have been reported in up to 1-60% of cases, although the rate varies in different countries. The most frequent extra-oral sites of gastrointestinal involvement are the ileocecal region and the colon. Gastric or esophageal involvement is reported to be very rare. Moreover, there have been no reports on the simultaneous involvement of the esophagus, stomach, ileum, and colon. Here, we present a 55-year-old Korean man with intestinal BD and multiple ileal and colonic ulcerations complicated by perforation, gastric ulcer with bleeding followed by perforation, and esophageal ulcers with bleeding.
Behcet Syndrome/complications/*diagnosis/pathology ; Cecal Diseases/complications/pathology ; Diagnosis, Differential ; Endoscopy, Digestive System ; Gastrointestinal Diseases/complications/*diagnosis ; Gastrointestinal Hemorrhage ; Humans ; Intestinal Perforation/*diagnosis/etiology/pathology ; Male ; Middle Aged ; Peptic Ulcer Perforation/pathology ; Stomach Ulcer/complications/pathology

OBJECTIVETo study the long-term results of extended parietal cell vagotomy (EPCV) in the treatment of patients with duodenal ulcer and their complications.

METHODSForm 1979 to 2001, EPCV was performed in 321 patients with duodenal ulcer and their complications. Of these patients 56 had chronic duodenal ulcer, 204 perforation, 16 hemorrhage and 40 stenosis. The following items were evaluated: complications of operation, gastric secretion, gastric emptying, endoscopical and radiographical findings, nutritional status, absorption function, and Visick scale.

RESULTSPostoperative follow-up ranged from 0.5 to 22.0 years (mean 11.3 years) in 289 of the 321 patients with a follow-up rate of 90.0%. Neither operative mortality nor dumping syndrome was noted. Episodic postprandial fullness occurred in 19 patients (6.5%), acid regurgitation in 17 (5.8%) and adhesive ileus in 4 (1.4%). Ulceration recurred in 16 patients (5.5%). Duodenal ulcer was seen in 8 patients (19.5%), hemorrhage in 0 (0%), stenosis in 2 (5.3%), and perforation in 6 (3.1%). Ulcers healed rapidly after medical therapy in 10 patients. Six patients received antrectomy and gastrectomy. In 289 (91.7%) patients of Grade I and II of Visick scale, 191 (95.3%) had perforation.

CONCLUSIONSEPCV is easy to perform with a low rate of post operative complication and ulcer recurrence. It should be a treatment of choice for acute perforation, hemorrhage or stenosis due to duodenal ulcer.

Duodenal Ulcer ; surgery ; Female ; Follow-Up Studies ; Gastric Acid ; secretion ; Gastroscopy ; Humans ; Male ; Peptic Ulcer Perforation ; surgery ; Postoperative Complications ; etiology ; Recurrence ; Vagotomy ; adverse effects ; methods

OBJECTIVETo evaluate the long-term therapeutic efficacy of extended parietal cell vagotomy (EPCV) in the treatment of duodenal ulcer complicated with acute perforation.

METHODSTherapeutic efficacy of EPCV in 176 cases subjected to duodenal ulcer with acute perforation since 1979 was evaluated, including postoperative complication, ulcer recurrence rate, gastric empting function, endoscopic and radiographical examination, nutritional status and Visick classification.

RESULTSAmong 176 patients, 153 (86.9%) cases were successfully followed-up for 5 years after operation. No operative death was found. Postprandial superior belly fullness occurred in 13 cases (8.5%) and heartburn in 12 cases (7.8%), which could be relieved by Domperidone. Adhesive ileus was noted in 4 cases (2.6%) which was cured by adhesiolysis. The total ulcer recurrence rate was 2.6% (4 cases) within 2 to 3 years after operation. Superficial gastritis occurred in 21 cases (13.7%) and duodenal bulb in 31 cases (20.3%). Sinus ventriculi vermicular motion was good and gastric emptying was normal. No anemia was found. Body weight gained in 116 cases (75.8%). One hundred and forty-six cases(95.4%) were reforming Visick grade I and II , 3 cases(2.0%) grade III , and 4 cases (2.6%) IV .

CONCLUSIONSEPCV is convenient for performance with low postoperative complication rate. Its long-term efficacies are quite good, which including normal nutritional status, high quality of life and low ulcer recurrence rate. EPCV is one of effective and safe treatments for duodenal ulcer complicated with acute perforation.

Adolescent ; Adult ; Aged ; Duodenal Ulcer ; complications ; surgery ; Female ; Humans ; Male ; Middle Aged ; Peptic Ulcer Perforation ; etiology ; surgery ; Treatment Outcome ; Vagotomy, Proximal Gastric ; Young Adult

PURPOSE: Safe and effective surgical treatment of peptic ulcer perforations is fundamental to achieve favorable outcomes. We present laparoscopic single figure of eight suturing omentopexy for perforated duodenal ulcer and review associated clinical outcomes. This is a new formulaic surgical technique for laparoscopic omentopexy. METHODS: Laparoscopic single figure of eight suturing omentopexies for perforated duodenal ulcer were completed in 15 consecutive patients between April 2008 and November 2017 at Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea. Using prospectively collected data, we performed an observational study on an intention-to-treat basis. RESULTS: The mean age of the 15 patients who underwent laparoscopic repair was 41.7±13.9 years. The perforation site was the anterior duodenal bulb in all patients. The median perforation size was 5 mm (range: 3~8 mm). The mean operation time was 66.7±19.6 minutes. There was no evidence of leakage from the omentopexy site clinically or in the postoperative upper gastrointestinal series. One patient (6.7%) experienced the postoperative complication of pneumothorax. There were no cases of postoperative mortality or reoperation within 30 days after surgery. The median time to tolerance of regular diet was 6 (range: 4~9) days. The median postoperative hospital stay was 7 days (range: 5~11 days). CONCLUSION: Laparoscopic single figure of eight suturing omentopexy can be a viable option in the surgical management of perforated duodenal ulcer in selected patients without surgical risk factors. Laparoscopic single figure of eight suturing omentopexy is safe and easy to perform, and may therefore reduce operation time.
Diet ; Duodenal Ulcer ; Humans ; Korea ; Laparoscopy ; Length of Stay ; Mortality ; Observational Study ; Peptic Ulcer Perforation ; Pneumothorax ; Postoperative Complications ; Prospective Studies ; Reoperation ; Risk Factors ; Seoul

PURPOSE: After the introduction of peptic ulcer medication, a marked decrease took place in the number of patients with uncomplicated peptic ulcers subjected to elective surgery. This decline, however, was not associated with a decrease in the number of patients admitted with peptic ulcer perforation. Also, the morbidity and mortality were increased because the perforated peptic ulcers mostly occurred in elderly patients with medical illnesses. The purpose of this study was to evaluate the postoperative morbidity in patients with a perforated peptic ulcer. METHODS: Between January 2000 and December 2005, 110 consecutive patients, who underwent surgery for perforated peptic ulcer at Seoul Red Cross Hospital department of general surgery, were retrospectively reviewed. RESULTS: The overall morbidity and the mortality rates were 23.6 and 5.45%, respectively. The most common postoperative complication was postoperative ileus, followed by wound infections and pulmonary complications. The most common cause of death was sepsis. A univariate analysis showed sex, age, a delayed operation, site and size of perforation, the size of crater, comorbid diseases, and type and duration of operation were associated factors; however, the multivariate analysis showed age, a delayed operation, size of perforation, comorbid diseases, and type and duration of operation were independent risk factors. CONCLUSION: Age, a delayed operation, size of perforation, comorbid diseases, and type and duration of operation were independent risk factors for a perforated peptic ulcer. Therefore, to decrease the postoperative morbidity, comorbid diseases must be treated during the perioperative period, perforated peptic ulcer must be correctly diagnosed immediately and short time consuming operative procedures must be performed.
Aged ; Cause of Death ; Hospital Departments ; Humans ; Ileus ; Mortality ; Multivariate Analysis ; Peptic Ulcer Perforation ; Peptic Ulcer* ; Perioperative Period ; Postoperative Complications ; Red Cross ; Retrospective Studies ; Risk Factors ; Seoul ; Sepsis ; Surgical Procedures, Operative ; Wound Infection

INTRODUCTIONLaparoscopic simple closure (LSC) coupled with Helicobacter pylori eradication is a well-recognised treatment for perforated duodenal ulcers. This study aimed to evaluate its safety and efficacy.

METHODSThis was a retrospective cohort study conducted on patients who underwent LSC of perforated duodenal ulcers from January 2002 to December 2009. Patients were stratified according to the American Society of Anesthesiologist classification and Boey's risk score.

RESULTSOf the 213 patients, 22 (10.3%) were excluded as they required conversion to open surgery. 191 (89.7%) patients who underwent successful laparoscopic repair were included in the study. The median age of the patients was 39 (range 19-73) years, and the majority were male (n = 180, 94%). Median duration of pre-hospital symptoms was eight hours and median time from admission to surgery was six hours. Median operative time was 65 minutes and median hospital stay was five days. Ten patients (median age 53.5 years) required intensive care unit admission. Two patients developed leakage from the suture line - one required re-exploration and the other was managed conservatively. Four patients had intra-abdominal abscesses - one required re-exploration, while three were managed by percutaneous radiological drainage. One patient developed pneumonia and one had pulmonary embolism. There were no surgical site infections. All patients were followed up as surgical outpatients (median duration 36 days). None of the patients required definitive surgery. There was one death in the cohort.

CONCLUSIONLSC of perforated duodenal ulcers is a reliable, safe and minimally invasive procedure that has low morbidity.

Adult ; Aged ; Duodenal Ulcer ; diagnosis ; surgery ; Female ; Humans ; Laparoscopy ; methods ; Male ; Middle Aged ; Peptic Ulcer Perforation ; surgery ; Postoperative Complications ; prevention & control ; Retrospective Studies ; Time Factors ; Treatment Outcome ; Young Adult

Intrahepatic abscess is an unusual complication of peptic ulcer disease. We present a case of gastric cancer in which the ulcer penetrated into the left lobe of liver with subsequent abscess and fistula formation. Esophagogastroduodenoscopy confirmed ulcers and a fistula opening in the antrum. Abdominal computed tomogram showed a subcapsular liver abscess adjacent to the gastric antrum. Subtotal gastrectomy with curettage of the fistulous tract was performed. The final diagnosis was the signet ring cell gastric carcinoma complicating subcapsular liver abscess. To our knowledge, this is the first reported case in Korea.
Endoscopy, Gastrointestinal ; Female ; Humans ; Klebsiella pneumoniae/isolation & purification ; Liver Abscess/diagnosis/*etiology/microbiology ; Middle Aged ; Peptic Ulcer Perforation/*complications/diagnosis ; Stomach Neoplasms/complications/*diagnosis/surgery ; Tomography, X-Ray Computed

PURPOSE: To evaluate the radiological findings and clinical courses of the complications arising after nonbiliary laparoscopic gastrointestinal surgery (NLGS). MATERIALS AND METHODS: We retrospectively reviewed the clinical records of 131 patients who underwent NL-GS (83 cases involving colorectal surgery, 18 splenectomies, 14 appendectomies, ten adrenalectomies, three lumbar sympathectomies, two Duhamel 's operation, and one peptic ulcer perforation repair) over a four-year period. Among these 131 patients, the findings of fifteen in whom postoperative complications were confirmed were analysed. The radiologic examinations these patients underwent included CT (n = 8), barium enema and fistulography (n = 4), ultrasonography (n = 3), ascending venography of the lower legs (n = 2), and penile Doppler sonography (n = 1). We evaluated the radiologic findings and clinical courses of early (within 2 weeks) and late (after 2 weeks) postoperative complications. RESULTS: Sixteen cases of postoperative complications developed in fifteen patients ; in 14 (17%) after colorectal surgery and in one (6%) after splenectomy. Eleven of the sixteen cases (69%) involved early complications, consisting of an abscess in three, ischemic colitis in two, hemoperitoneum in one, perforation of the colon in one, pancreatitis in one, recto-vaginal fistula in one, deep vein thrombosis after colorectal surgery in one, and abscess after splenectomy in one. The remaining five cases (31%) involved late complications which developed after colorectal surgery, comprising anastomosic site stricture in two, abdominal wall (trocar site) metas-tasis in one, colo-cutaneous fistula in one, and impotence in one. Among the 16 cases involving postoperative complications, recto-vaginal fistula, colon perforation, and abdominal wall metastasis were treated by surgery, while the other thirteen cases were treated conservatively. CONCLUSION: Various postoperative complications develop after NLGS, with a higher rate of these being noted in cases involving colorectal surgery than in other cases.
Abdominal Wall ; Abscess ; Adrenalectomy ; Appendectomy ; Barium ; Colitis, Ischemic ; Colon ; Colorectal Surgery ; Constriction, Pathologic ; Enema ; Erectile Dysfunction ; Fistula ; Hemoperitoneum ; Humans ; Laparoscopy ; Leg ; Male ; Neoplasm Metastasis ; Pancreatitis ; Peptic Ulcer Perforation ; Phlebography ; Postoperative Complications ; Retrospective Studies ; Splenectomy ; Sympathectomy ; Ultrasonography ; Venous Thrombosis