Traitement chirurgical des complications des ulceres. Les perforations des ulceres gastroduodenaux au centre. Peritonite par perforation dulcere gastroduodenal universite cadi. About a retrospective study from january 1st 2006 to march 31st, 2012 in visceral surgery at cnhu of cotonou, records of 86 cases of duodenal or gastric ulcer perforation were analyzed. Peritonitis due to peptic ulcer perforation is a surgical emergency with a high risk of mortality and morbidity. Perforated duodenal ulcers are rare complications seen after rouxeny gastric bypass rygp. A free powerpoint ppt presentation displayed as a flash slide show on id.
Duodenal ulcer perforations who are decided for nonsurgical treatment on a clinical ground, that is history of nsaidsteroid intake stable haemodynamic status localized minimum abdominal pain localized tenderness andor rigidity no or minimum gas shadow under the domes of. Management of acute duodenal peptic perforations request pdf. Results of conservative treatment for perforated gastroduodenal ulcer in patients not eligible for surgical repair. Fasgip protocol focused assessment with sonography for gastrointestinal perforation. T ension pneumoperitoneum tpp, also known as hyperacute abdominal compartment syndrome or abdominal tamponade, is a rare condition most commonly associated with gastrointestinal gi perforation during endoscopy and iatrogenic insufflation of gas into the peritoneal cavity. The diagnosis was based on typical peptic ulcer symptoms, hyperchlorhydria, and barium meal xray studies delineating a duodenal bulb deformity with an ulcer crater in 8 patients.
L ulcere gastroduodenal est une maladie chronique recidivante. A critical evaluation of surgical treatment of perforated ulcer. Expectant management of perforated duodenal ulcer kings county hospital sylvia s. Les peritonites par perforation d ulcere gastroduodenal chez lenfant. Diagnostic delay is common, as the true history is concealed and signs may be minimal. The treatment of perforated ulcer disease continues to evolve because of recent advances in pharmacology, bacteriology, and operative techniques. The finding of pneumoperitoneum may allow for a definitive diagnosis at the bedside within minutes for the patient with an acute abdomen. We present a rare case of a 54yearold caucasian man who underwent an emergency laparotomy for peritonitis caused by perforation of two peptic ulcers. Synchronous perforation of a duodenal and gastric ulcer. A few perforations however result in lifethreatening retroperitoneal necrosis and require surgical intervention. Elle reste malgre lefficacite du traitement medical, une affection frequente et.
Diagnostic dun ulcere duodenal perfore diagnosis of a perforated duodenal ulcer 0 1 l. Acute perforation of a duodenal ulcer is a calamity that demands prompt surgical treatment. The commonest reason for conversion to open surgery is a perforation size of more than 1 cm. Pdf results of conservative treatment for perforated. The interval between the perforation and the operation is of great significance. Safety of nonsurgical treatment of duodenal ulcer perforation 8 inclusion criteria. Pdf les peritonites par perforation dulcere gastroduodenal.
The pyloric thickening seen on ct was due to edema in the wall. Duodenal perforation after endoscopic procedure federal. We report three cases, all with other features typical of nonaccidental injury. Very little data is available in literature regarding the definition, incidence, and the management of large perforations of duodenal ulcers. Duodenal or gastric ulcer perforations constitute a medical and surgical emergency. This large perforation was successfully diagnosed and repaired laparoscopically. This paper represents our experience with the management of this subset of duodenal ulcer perforations over a period of three years from january 2001 to december 2003. Despite antisecretory medication and helicobacter pylori eradication, it is still the most common indication for emergency gastric surgery associated with high morbidity and mortality. Double contrast computed tomography is the most sensitive investigation to confirm clinical suspicion. The first was located on the anterior wall of the duodenum and the second was posterior, prepyloric, close to the lesser curvature. Some underlying causes of gastroduodenal perforation have been reported but remain largely. Ppt ulcere gastroduodenal powerpoint presentation free to. Argumenter lattitude therapeutique et planifier le suivi du patient.
The management of large perforations of duodenal ulcers bmc. Syndrome ulcereux, syndrome dyspeptique, hemorragies digestive, perforation. Gastroduodenal peptic ulcer perforation listed as gpup. Perforation of 1st part of duodenum was confirmed on endoscopy. Jun 19, 2011 the treatment of perforated ulcer disease continues to evolve because of recent advances in pharmacology, bacteriology, and operative techniques. Duodenal perforation is a rare, life threatening injury associated with nonaccidental blunt abdominal trauma. Axial contrastenhanced ct image of the upper abdomen demonstrates pneumoperitoneum along the anterior abdomen arrows. Laparoscopic repair of a large duodenal perforation secondary. Bedside abdominal us is a valuable clinical bedside tool for identifying free air in the abdominal cavity. A therapeutic alternative for perforated gastroduodenal ulcer in the context of actual trends towards an efficient and less aggressive therapy of peptic ulcer, it. Perforation of the stomach is a fullthickness injury of the wall of the organ. The responsibility of the physician who first sees a patient following perforation is grave. Identifier les situations durgence et planifier leur prise en charge.
Figure 11a figure 11b figure 11c figure 11d findings figure 11a. Eleven cases of chronic duodenal ulcer in children were subjected to surgical treatment in a period of 7 years. Non operative management of perforated duodenal ulcers. We present two patients with perforated duodenal ulcers and a distant history. They often present as a diagnostic dilemma as they rarely present with pneumoperitoneum on radiologic evaluation.
Duodenal perforation is an uncommon complication of endoscopic retrograde cholangiopancreatography ercp and a rare complication of upper gastrointestinal endoscopy. High prevalence of helicobacter pylori infection in duodenal ulcer perforations not caused by non. Interestingly, those at the highest risk of contracting peptic ulcer disease are those. Surgical management of duodenal perforations after ercp. Introduction peptic ulcer disease represents a serious medical problem. There is suspicion for a small tract of contrast which could represent the site of viscus perforation in the region of the junction of the first and second part of the duodenum. The first was located on the anterior wall of the duodenum and the second was posterior, prepyloric, close to the lesser. H pylori plays a central role high % of h pylori infections reported with perforated duodenal ulcers. Perforated peptic ulcer kjetil soreide, kenneth thorsen, ewen m harrison, juliane bingener, morten h moller, michael oheneyeboah, jon arne soreide perforated peptic ulcer is a common emergency condition worldwide, with associated mortality rates of up to 30%.
Clinical and radiographic features can be used to determine which type of surgical or conservative treatment of ercprelated duodenal perforations, whereas intraoperative findings can determine the final outcome and morbidity or mortality. Les perforations d ulcere gastroduodenal au centre national hospitalier et. Aug 18, 2010 peritonitis due to peptic ulcer perforation is a surgical emergency with a high risk of mortality and morbidity. Mdct identified pneumoperitoneum in 15 of 15 cases as compared with three of nine cases for plain films. Perforated pyloroduodenal peptic ulcer and sonography. Les perforations dulcere gastroduodenal au centre national. Diagnosis and treatment of perforated or bleeding peptic. Since peritoneum completely covers the stomach, perforation of the wall creates a communication between the gastric lumen and the peritoneal cavity. Case reports in surgery hindawi publishing corporation. If the perforation occurs acutely, there is no time for an inflammatory reaction to wall off the perforation, and the gastric content is free to enter the general. Most are minor perforations that settle with conservative management.
Patient was taken for laparotomy, duodenal perforation was sealed with om. Ng et al reported 80% 58 of 73 case of pdu were infected. There is no consensus as to the pathophysiology of these ulcers. Three cases of duodenal ulcer perforation in infants were diagnosed at laparotomy for peritonitis with.
Jun 25, 2005 very little data is available in literature regarding the definition, incidence, and the management of large perforations of duodenal ulcers. Diagnostic dun ulcere duodenal perfore pdf paperity. A few perforations however result in lifethreatening retroperitoneal necrosis and require surgical. The purpose of this article is to illustrate the spectrum of sonographic findings in perforated pyloroduodenal peptic ulcer and discuss the potential role of sonography in the diagnosis. Approximately 500,000 new cases are reported each year, with 5 million people affected in the united states alone. For this reason surgeons have shown it the greatest consideration. Diagnosis and treatment of perforated or bleeding peptic ulcers.