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A bacteriological study of perforated duodenal ulcers
N Shinagawa1, M Muramoto, S Sakurai
1First Department of Surgery, Nagoya City University Medical School, Japan.
The Japanese Journal of Surgery
|January 1, 1991
Summary
Bacterial cultures from perforated duodenal ulcers showed lower positivity rates compared to colon perforations. This suggests bacteria play a minor role in early duodenal perforation, supporting primary closure without drainage.
Area of Science:
- Gastroenterology
- Surgical Infections
- Microbiology
Background:
- Perforated duodenal ulcers are a surgical emergency.
- Understanding the role of bacterial contamination is crucial for treatment strategies.
Purpose of the Study:
- To compare the bacteriology of peritoneal fluid in perforated duodenal ulcers versus other perforations.
- To evaluate the role of bacteria in the pathogenesis of early duodenal perforation.
Main Methods:
- Peritoneal fluid samples were collected from 63 patients with perforated duodenal ulcers.
- Bacteriological examination of peritoneal fluid was performed.
- Results were compared to 175 patients with other types of perforations.
Main Results:
- Bacterial culture positivity was 100% in colon perforations vs. 44.4% in duodenal perforations.
- Duodenal perforations often yielded negative cultures, especially with short intervals to surgery.
- Aerobes were the predominant isolates in duodenal perforations, unlike mixed flora in lower digestive tract perforations.
Conclusions:
- Bacteria appear to play a minor role in early-stage duodenal perforation.
- Primary closure without drainage may be suitable for early duodenal perforations after lavage.
- Conservative therapy might be possible for localized peritonitis if the stomach is empty and treatment is prompt.