perforated ulcer in elderly

Perforated peptic ulcer (PPU) is a serious complication of PUD and patients with PPU often present with acute abdomen that carries high risk for morbidity and mortality. 2007. Perforated peptic ulcer (PPU) is a surgical emergency and is associated with short-term mortality and morbidity in up to 30 and 50% of patients, respectively.1Worldwide variation in demography, socioeconomic status, Helicobacter pyloriprevalence and prescription drugs make investigation into risk factors for PPU difficult. It concerns an elderly patient under emergency surgery for peritonitis from a large perforated gastric ulcer. Perforated peptic ulcer presents as an acute abdominal condition, with localised or generalised peritonitis and a high risk for development of sepsis and death. Elderly patients suffer from frailty syndrome. The mortality rate of perforated peptic ulcer is still high particularly for aged patients and all the existing scoring systems to predict mortality are complicated or based on history taking which is not always reliable for elderly patients. 1997;21(4):412- . Perforated peptic ulcers in this series is a disease affecting young adults, the middle aged and the elderly, the peak incidence occurring between the fifth andseventh decades oflife. Being closely related to advanced age, increased burden of comorbidity may partially explain the higher mortality among elderly patients. The incidence of complicated peptic ulcer disease (PUD), including perforated and bleeding peptic ulcer, increases with advanced age [1,2].This increase has been attributed to the high frequency of risk factors for PUD among elderly patients, e.g., Helicobacter pylori colonization or use of non-steroidal anti-inflammatory drugs (NSAIDs) []. Back; Journal Home; Online First; Current Issue; All Issues; Special Issues; About the journal; Journals. Persons over the age of 60 constitute between 10 and 25% of all patients suffering from peptic ulcer disease. 24(10):815-28. Drugs Aging . Timely diagnosis and early surgical management of perforated peptic ulcers was imperative for elderly patients. Perforated peptic ulcers are life-threatening conditions with a mortality rate that approaches 30%. 2015 Sep 1;98(9):45-6. (Case Report) by "Case Reports in Oncological Medicine"; Health, general Aged patients Care and treatment Cancer Chemotherapy Cogeneration power plants Elderly patients Gastrointestinal diseases Non-Hodgkin's lymphomas Pancreatitis Radiotherapy Vincristine females and 10 males; the mean age was 75 years). Perforated ulcer in the elderly. The delay in treatment is due to a delayed hospitalization of old patients, who show a low reactivity to the disease. Stercoral ulcer is an ulcer of the colon due to pressure and irritation resulting from severe, prolonged constipation due to large bowel obstruction. If in young and adulthood this disease affects predominantly male persons, then in old age there is an increase in the incidence among women, and after 70 years the differences in . Ulcer perforation was frequently treated by gastric resection in former days, whereas suture, being the first method introduced in 1887, is the method of choice today. Because of suggestions that an increased perforation rate in elderly people could be associated with the consumption of non-steroidal anti-inflammatory drugs (NSAIDs),1,2 we compared trends in the frequency of admission with perforated ulcer in the United Kingdom from 1958 to 1982 with precription rates for NSAIDs and with changes in national . Patients with perforated peptic ulcer disease usually present with a sudden onset of severe, sharp abdominal pain. Ageing is a strong predictor for a poor outcome after perforated and bleeding peptic ulcer independently of comorbidity, and analyses stratified by comorebidity consistently showed high MRRs among elderly patients, regardless of comOrbidity. Gastric Perforation Following Nasogastric Intubation in an Elderly Male R I Med J (2013). Perforated ulcer; Other names: Ruptured ulcer: Endoscopic image of a posterior wall duodenal ulcer with a clean base, which is a common cause of upper gastrointestinal hemorrhage and could potentially lead to perforation. Conclusion: The laparoscopic approach is an effective method for treatment of perforated peptic ulcer in the elderly with a great diagnostic and therapeutic role. 3d. 1. My email alerts Due to the size of the ulcer and . Thus, failure to diagnose this condition accurately may be the principal cause of death in elderly patients with a perforated peptic ulcer. The risk of mortality (6-30%) and morbidity (21-43%) at PPU unfortunately have not chan-ged during the last decades [1,3-6]. The relative incidence of peptic ulcer perforation in the elderly is rising, and the optimal surgical treatment has yet to be defined. : Clinical profile and outcome of Wiznitzer T. Perforated Duodenal Ulcer in surgical treatment of perforated peptic ulcers Elderly Patient. Advances in perioperative care have greatly improved the outcomes of laparoscopic emergency surgery, allowing increasing numbers of patients, even the elderly, to undergo safe repair. Peptic Ulcer Perforation / diagnostic imaging Results: Among the 42 patients, 20 patients had liver involvement by a perforated duodenal ulcer and 22 by a gastric ulcer. Stercoral ulcer perforation commonly occurs in the sigmoid colon (50%) and rectosigmoid junction (24%) 12). Being closely related to advanced age, increased burden of comorbidity may partially explain the higher mortality among elderly patients. Europe PMC is an archive of life sciences journal literature. This factor is still the most important in the elderly being responsible of the high mortality rate. Free Online Library: Successful Use of a Multidisciplinary Approach to Treat a Perforated Duodenal Malignant Lymphoma in an Elderly Patient. To rules of admittance it can be assumed that only a few patients evaluate the long-term result after simple closure a follow-up study was from the . Subscribe; My Account . The cohort was first limited to patients greater than or equal to 65 y old, given that the elderly have been previously defined with this cutoff age. We computed age-, gender- and comorbidity-standardized 30-day mortality rates and used Cox's regression to estimate adjusted 30-day mortality rate ratios (MRR) for elderly compared with younger patients. Limited data exist on how the higher burden of comorbidity among . Peptic ulcer disease (PUD) is one of the most common gastroduodenal disorders. However, clinical features of PUP in elderly patients are different from those of young or in adult patients; indeed, symptoms of PUP may be atypical in old age. Limited data exist on how the higher burden of comorbidity among . Patients presenting with complications of peptic ulcer disease are most commonly in the 7thand 8thdecades of life and there is a male predominance with roughly 1.5 times as many cases in men than women3, 10. Because of suggestions that an increased perforation rate in elderly people could be associated with the consumption of non-steroidal anti-inflammatory drugs (NSAIDs),1,2 we compared trends in the frequency of admission with perforated ulcer in the United Kingdom from 1958 to 1982 with precription rates for NSAIDs and with changes in national . Gastric perforation is a surgical emergency that requires prompt diagnosis and treatment. ulcer are too friable to be safely closed by simple . Conclusions: Although perforated peptic ulcer in the elderly patients is associated with high morbidity and mortality, we should not delay the surgical intervention for patients with advanced age. Peptic ulcer disease in the elderly is a common disease. Nowadays more prospective . Results: Among 2,061 patients with perforated peptic ulcer, 743 (36%) were 65-79 years old and 513 patients (25%) were aged 80+ years. In elderly patients, acute appendicitis has a mortality of 35% and a morbidity of 50%. Iatrogenic sources of perforation include esoph-agogastroduodenoscopy (EGD), but are an uncommon complication. Background. Nonsteroidal antiinflammatory drugs have been implicated as a cause of the increased morbidity and mortality from painless bleeding or perforated gastric ulcers 24, 25 in the elderly, although . Once relatively common across all age groups, in the 21stcentury peptic ulcer disease is predominantly a disease of the elderly. Background Surgery for perforated peptic ulcer disease is one of the most common emergency procedures carried out in the western world.The role of postoperative empiric Helicobacter Pylori eradication therapy is controversial. T1 - Perforated peptic ulcer. During a 10-year period, 35 such patients were operated on; in all omentopexy was performed. This Journal. 39 Another series of 107 patients with perforated pyloroduodenal ulcers documented minimal morbidity, low mortality, excellent patient satisfaction for omental patching and HSV, with a recurrence rate of 3.7% for duodenal ulcer; the recurrence rate . Patients frequently report that the pain started "as if someone flipped a switch." However, elderly patients frequently present with a less robust onset of pain. 39 Another series of 107 patients with perforated pyloroduodenal ulcers documented minimal morbidity, low mortality, excellent patient satisfaction for omental patching and HSV, with a recurrence rate of 3.7% for duodenal ulcer; the recurrence rate . Elderly patients suffer from frailty syndrome. 1985 Dec 7;2(8467):1309. In 3 of the 32 patients, the diagnosis of perforated ulcer was established only at autopsy. Ageing is a strong predictor for a poor outcome after perforated and bleeding peptic ulcer independently of comorbidity, and analyses stratified by comorebidity consistently showed high MRRs among elderly patients, regardless of comOrbidity. Occasionally, patients will complain of left shoulder pain from diaphragmatic irritation . To evaluate the long-term result after simple closure a follow-up study was initiated at a Swedish community hospital. 2007. Perforation was the cause of death in 70% of the patients with peptic ulcer and Drugs Aging . Again there was a sample bias in the group as the unstable and elderly patients were excluded. Stercoral ulcer perforation should be suspected in elderly and in anyone with a history of constipation with unexplained abdominal pain and investigated appropriately with a CT scan to allow timely and optimal treatment. Results: Among the 42 patients, 20 patients had liver involvement by a perforated duodenal ulcer and 22 by a gastric ulcer. Among the 23 cases of known ulcer histology, 2 ulcers were malignant and were adenocarcinomas in the gastric remnant and the remaining 21 ulcers were confirmed as histologically benign (for frequency of malignancy in duodenal versus gastric ulcers, p = 0.48). This topic will provide an overview of the complications of PUD and their general management. Early diagnosis is essential, but clinical signs can be obscured in elderly people or immunocompromised patients, thus delaying diagnosis. TABLE II AGE DISTRIBUTION OF 73 PATIENTS WITH PERFORATED PEPTIC ULCERS Age Numberof cases o-19 years 0 20 - 29 years 10 30 - 39 years 8 40 - 49 years 20 50 - 59 . This is known as peritonitis. : Specialty: Gastroenterology : Symptoms: Abdominal pain, vomiting, nausea: Complications: Bowel perforation, sepsis, gastrointestinal hemorrhage . All these factors make the elderly patient a major challenge for a laparoscopy treatment. Again there was a sample bias in the group as the unstable and elderly patients were excluded. These changes can be attributed to a cohort phenomenon: Ulcer perfora-tion risk is particularly . A major contributing factor to morbidity and mortality in these patients is the presence of 1 or more severe . AU - Hussain, Nasir. Perforated peptic ulcer is a serious condition with an overall reported mortality of 5%-25%, rising to as high as 50% with age [ 4 - 6 ]. Giant gastric ulcer (GGU) is defined as an ulcer more than 3 cm in diameter. Jacyna MR, Shepherd AN. A silent gastric perforation, however, is one of the rare conditions in . [7] An initial emergent surgery consultation is required in all patients with peritonitis even before definitive diagnosis. TY - JOUR. N2 - Better medical management has reduced the incidence of peptic ulcer disease (PUD), but the burden of the disease and its complications has shifted toward the elderly - who may have only mild symptoms and no PUD history whatsoever when they present with perforation. Multiple clinical variables were significantly more common in the elderly group of . Access provided by MSN Academic Search . Authors Adam Janicki 1 , Chad Van Ginkel 1 , Jamieson Cohn 1 Affiliation 1 Department . Methods The clinical, operative and postoperative surveillance details of 84 consecutive patients who underwent surgery for perforated peptic ulcer were reviewed . Can J. Surg. Back; The Lancet; The Lancet Child . Perforated peptic ulcer presents as an acute abdominal condition, with localised or generalised peritonitis and a high risk for development of sepsis and death. Perforation. The postoperative morbidity rate was 62 percent, and the mortality rate 17 percent. Thus, failure to diagnose this condition accurately may be the principal cause of death in elderly patients with a perforated peptic ulcer. The cohort was first limited to patients greater than or equal to 65 y old, given that the elderly have been previously defined with this cutoff age. make investigation into risk factors for perforated peptic ulcer diffi cult. Early diagnosis is essential, but clinical signs can be obscured in elderly people or immunocompromised About one of four ulcer perforations can be attributed to the use of nonsteroidal antiinflammatory drugs, a risk factor of particular importance in the elderly. Perforated peptic ulcer: long-term results after simple closure in the elderly. About one of four ulcer perforations can be attributed to the use of nonsteroidal antiinflammatory drugs, a risk factor of particular importance in the elderly. ing peptic ulcers require surgical intervention whereas al-most all patients with perforated peptic ulcer (PPU) necessitate surgery [1]. A rarer complication of stomach ulcers is the lining of the stomach splitting open, known as perforation.

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