nonoperative managment perforated peptic ulcers

1. Conservative management of
perforated peptic ulcers
Zeeshan Rahman

2. Peptic ulcer disease
• Most prevalent disease of the gastrointestinal
tract.
• Incidence: 0.1 – 0.3 % in western countries.
• Major precipitating factors:
1.Helicobacter pylori infection
2.NSAID drug abuse

3. Epidemiology
• Decreasing incidence of peptic ulcer disease
- Discovery of PPI/H2 antagonist
- Discovery of H.pylori

4. • In 2005 Barry J. Marshal and J. Robin Warren
discovered the role of H. pylori in peptic ulcer

5. PUD
• Considered a derangement in the mucosal
function of the stomach and duodenum

6. Complications
• Bleeding
• Perforation
• Obstruction

7. Perforation
• Incidence : 5 – 10% in patients with active
ulcer disease
• Duodenal perforation: 60%
• Antral perforation: 20%
• Gastric perforation: 20%

8. Taylor (20th
century)
• Study on non-operative management of
peptic ulcer.
• 256 patients treated non-operatively for
peptic ulcer disease.
• 21 needed surgical intervention
• Overall mortality rate was 11%
• Usual operative mortality rate – 22%

9. Reason for poor acceptance
• Need for close clinical monitoring of patients
6-12 hours after perforation : Stage of delusion
- Acute pain of peritonitis subsides
- Abdominal rigidity lessens
- Leakage of enteric contents continue

10. Types of peptic ulcer perforations

11. When to decide to offer
conservative management
• Sealed perforations
• Water soluble contrast medium- Gastrograffin
study used
• 40% of patients examined – No releak
• Incidence of releak – 2 in 109 patients

12. Treatment options

13. Conservative management of
perforated peptic ulcers