A Study on Clinical Outcome of Gastric Ulcer Perforation: A Prospective study

INTRODUCTION: Gastric ulcer perforation is one of the acute abdominal emergencies in the surgical field. The incidence of peptic ulcer disease has been declining for the past 25 years and the need for the elective ulcer surgery is on decline, neither the incidence nor the need for surgery for the emergent complications of the ulcer (perforation, bleeding and obstruction) have changed significantly during the past 20 –25 years. This study deals with one of the complications of peptic ulcer, namely gastric ulcer perforation, trends in age distribution of occurrence, risk factors, outcome of operative treatment and factors influencing the prognosis of the disease. Gastric ulcer in the lesser curvature near the antrum perforates. Amount of gas escaped is more than the perforated duodenal ulcer. Malignancy should always be suspected and so biopsy from the edge of the ulcer is a must. Mortality in gastric ulcer perforation is high, commonly they are pre pyloric in position. Primary closure with an edge biopsy is commonly used. Distal gastrectomy including ulcer area is better option if patients general condition is favourable. Posterior gastric ulcer perforation is often difficult to diagnose both clinically and radiologically. Detailed history, good physical examination and good clinical acumen plays a major role in diagnosing this acute abdominal emergency. There is multiple factors influencing the progress of the disease and its prognosis which be discussed in detail in this study. AIM OF THE STUDY: The aim of the study are; 1. To study the age group, sex, causes, socioeconomic status, personal habits and 2. sensitivity of investigational modalities in diagnosis of gastric ulcer perforation. 3. To study the risk factors. 4. To study the prognostic factors influencing the disease process. 5. To study the outcome of operative treatment – morbidity and mortality. 6. Biopsy study from the edge of the ulcers and incidence of malignant ulcer perforation. MATERIALS AND METHODS: This study was conducted in Rajiv Gandhi Government General Hospital & Madras Medical College, Department of general surgery during the period of August 2012 – December 2012. The diagnosis of gastric ulcer perforation was that established by the admitting surgeon, clinical features and radiological report and confirmed at operation. Surgery was defined as urgent (less than 4 hrs between admission and surgery), same day(4-24 hrs) and delayed at a later time during the same hospital admission. Operative details includes the size, site of perforation and nature of operation performed. Mortality was defined as death following surgical procedure. Post operative morbidity was defined in terms of duration of hospital stay and associated complications following surgery. Exclusion Criteria: • Acute appendicitis, acute pancreatitis, acute cholecyatitis. • Traumatic gastric perforation. • Accidental gastric perforation during laparotomy. • Cases of delayed presentation with shock and septicemia whose general condition did not warrant any operative management even after all resuscitative measures. RESULTS: Fifty cases of gastric ulcer perforation were studied. All fifty cases underwent laparotomy and the perforation was found in the pyloric antrum. Malignant ulcer perforation found in one case. All cases were advised to continue anti H.Pylori treatment and proton pump inhibitors for 6 weeks post-operatively. CONCLUSION: Gastric ulcer perforation is now becoming more common in the age group