G. J. Roberts1, M. Cripps1, H. Phelan1, R. Mao1, T. Hranjec2, S. Hennessy1 1University Of Texas Southwestern Medical Center,General And Acute Care Surgery,Dallas, TX, USA 2Memorial Physician Group,Trauma,Hollywood, FL, USA
Introduction:
Peptic ulcer disease (PUD) affects over 4 million people worldwide annually, and up to 14% of them will develop a perforation. The selective nonoperative management of patients with perforated duodenal ulcers has been found to be safe and successful. However, the nonoperative management of perforated gastric ulcers is more questionable, especially when medical treatment and follow up are uncertain. We sought to evaluate our experience in the management of perforated peptic ulcers at a tertiary care public safety net hospital and compare operative and nonoperative management.
Methods:
A retrospective review of all patients with a perforated peptic ulcer at a single tertiary care public safety net hospital from April 2009 to August 2017 was performed. Data was obtained by chart review and included patient demographics, comorbidities, lifestyle factors, perioperative and in- hospital admission factors along with morbidity, mortality and follow-up. Patient outcomes and follow up after nonoperative versus operative management were compared by univariate analysis using Wilcoxon rank sum, Chi-square, and Fisher’s exact tests where appropriate.
Results:
A total of 74 patients with perforated PUD were identified with 12 (16%) duodenal ulcers and 59 (80%) gastric ulcers, and 3 (4%) unknown. Overall 30-day mortality was 5.4% with a median length of stay of 7 days (range 2-70). Only 61.5% (43 patients) followed up in clinic with 11% of patients undergoing a subsequent EGD. Of these patients 14 (19%) were managed nonoperatively, of which 10 (71%) were gastric ulcer perforations.
Conclusion:
Clinic and endoscopic follow up after perforated peptic ulcer disease in a safety net hospital is suboptimal. In hemodynamically stable patients with perforated gastric ulcers without diffuse peritonitis, nonoperative management appears to be safe in the short term. However, given the lack of medical, biochemical, and endoscopic follow up in this patient population, one should strongly consider definitive operative management.
