Results of surgical treatment of perforated peptic ulcer

Introduction : Effective treatment with H₂-blockers and proton pump inhibitors almost removed the necessity of elective surgical treatment of refractory peptic ulcer disease. Life-threatening complications of peptic ulcer still occur and patients with perforated peptic ulcer almost always need surgical treatment.

Material and methods : Seventy-five consecutive patients aged 16-91 years (31 women and 44 men) operated on because of perforated peptic ulcer in our department between 1 January 2001 and 31 December 2009 were studied retrospectively.

Results : The mean age was 51.5 ±20.5 years. Of the 75 patients, 34 (45.3%) had co-morbid disease, 14 (18.6%) presented with a delay of more than 24 h, 16 (21.3%) were older than 70 years and 25 (33.3%) were assessed as ASA grade 3 or more. Postoperative complications occurred in 19 patients (25.9%). Cardio-pulmonary failure (5 patients) and wound infection (4 patients) were the most common. The mean hospital stay of recovered patients was 7.7 days (3-38). Eleven (14.6%) patients died. Age above 70 years, presence of co-morbid illness, presence of abdominal postoperative complications, American Society of Anesthesiologists (ASA) grade 3 or more, presence of shock on admission and gastric localisation of ulcer were identified as factors increasing risk of mortality.

Conclusions : The incidence of perforated peptic ulcer among elderly patients, females in particular, is increasing. The number of patients with perforated peptic ulcer as the first symptom of peptic ulcer is increasing. Perforated peptic ulcer still involves high postoperative mortality.