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Related Experiment Videos

Unsuspected perforation in bleeding duodenal ulcers.

K S Dasmahapatra1, W Suval, G W Machiedo

  • 1Surgical Service, VA Medical Center, East Orange, New Jersey 07019.

The American Surgeon
|January 1, 1988
PubMed
Summary

Simultaneous bleeding and perforation in peptic ulcer disease is rare but significantly increases operative mortality. Unsuspected perforations in bleeding patients can delay diagnosis and treatment, highlighting the need for vigilance.

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Area of Science:

  • Gastroenterology
  • Surgical Gastroenterology
  • Clinical Medicine

Background:

  • Peptic ulcer disease (PUD) complications, bleeding and perforation, rarely occur together.
  • Simultaneous presentation of bleeding and perforation in PUD poses diagnostic and therapeutic challenges.

Purpose of the Study:

  • To investigate the incidence and impact of unsuspected duodenal ulcer perforation in patients presenting with bleeding.
  • To compare operative mortality rates between patients with isolated bleeding, isolated perforation, and combined bleeding and perforation.

Main Methods:

  • Retrospective review of 127 patients who underwent surgery for peptic ulcer bleeding or perforation.
  • Analysis of patient demographics, clinical presentation, operative findings, and outcomes, including mortality.

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Main Results:

  • 9.9% of patients with bleeding peptic ulcers had unsuspected perforations.
  • Operative mortality was significantly higher in combined bleeding and perforation (44%) compared to bleeding alone (9.8%) or perforation alone (11.0%).
  • Nonsurvivors were older and had a longer duration of symptoms, with preoperative fever, leukocytosis, and tachycardia being common in non-survivors.

Conclusions:

  • Perforation is an under-recognized complication in patients with bleeding peptic ulcers.
  • Clinical signs of perforation may be masked by bleeding, leading to delayed surgical intervention and increased mortality.
  • Fever, leukocytosis, and tachycardia in bleeding peptic ulcer patients warrant suspicion for concurrent perforation.