Surgery, Gastroenterology and Oncology

Introduction: Acid-reduction surgery has been strongly advocated in past for perforated peptic ulcers because of the high incidence of ulcer relapse after simple closure. Since Most patients with Gastroduodenal perforation are associated with Helicobacter pylori (H. pylori) infection, Simple oversewing procedures either by an open or laparoscopic approach together with H. pylori eradication appear to supersede definitive ulcer surgery.

Material and Methods: Total number of 70 patients were included in this prospective study with diagnosis of perforation peritonitis admitted in emergency ward. These patients were operated in emergency by simple closure of perforation with omental patch repair.
Peroperative biopsy sample was taken from margin of perforation and sent for staining by H & E and Giemsa staining for H. pylori.
After 15 days endoscopic biopsy was taken from gastric antrum for H. pylori staining. Anti H. Pylori Eradication Therapy (Triple therapy--1 PPI + 2 antibiotic) for 14 days was given to the positive cases. These patients were followed for 1 year for recurrence of ulcer.

Results: Out of 70 consecutive patients (mean age = 47 years, range 15-75) of perforation H. pylori was seen in 48 patients (68.57%).
Total 28 patients (40%) were having h o use of NSAIDS in recent past. Male to female ratio was about 3:1 and most common age group was 46-55 years.
In the H. pylori positive patients, Anti H pylori eradication therapy was given. These all patients are in follow up and are asymptomatic in 3 months.

Conclusions: H. pylori is strongly associated with Gastro duodenal perforation, (48 70) 68.57% were positive for H. pylori. Gastric perforation was more common than duodenal perforation and prepyloric region was commonest site.
For H. pylori detection, biopsy and staining is a good method. Early Anti H. pylori therapy for patients of Gastro duodenal perforation who were positive for H. pylori, provide an excellent cure after simple closure of perforation.

Full Text Sources:
Abstract:   
Views: 2997