Impact of the coronavirus disease 2019 pandemic on the management of acute peptic ulcer perforation: to be reconsidered(?).

OBJECTIVE: Peptic ulcer perforation presents the most serious complication of ulcer disease with mortality that varies significantly depending on the age and conditions. The coronavirus disease 2019 pandemic was effective worldwide in 2020 and continues to date. The aim of this study was to investigate the initial clinical parameters and short-term outcomes of patients with acute peptic ulcer perforation before and during the coronavirus disease 2019 pandemic. METHODS: A retrospective cohort study was conducted in the Department of Surgery, University Hospital Ostrava, Czech Republic. The patients undergoing surgical modality of a simple suture of peptic ulcer perforation with/without omentoplasty in the post-coronavirus disease 2019 (January 1, 2020 to December 31, 2021) and the pre-coronavirus disease 2019 (January 1, 2018 to December 31, 2019) had been incorporated in this study. RESULTS: This study included a total of 46 cases (26 in the pre-coronavirus disease 2019, 20 in the post-coronavirus disease 2019). The age, body mass index, Boey score, duration of symptoms, surgery time, and length of hospital stay were comparable in both study subgroups. During the coronavirus disease 2019 pandemic, patients were admitted with a statistically significantly lower degree of perioperative risk according to the American Society of Anesthesiologists classification (p=0.013). Notably, 30-day postoperative morbidity was significantly higher in pre-coronavirus disease 2019 (73.1 vs. 55.0%, p=0.038). The mortality rate in the laparoscopic group was 13.6%, in the laparotomy group 41.4%, and the mortality rate was higher in pre-coronavirus disease 2019 than in post-coronavirus disease 2019 (34.6 vs. 20.0%, p=0.166). CONCLUSION: In fact, the coronavirus disease 2019 pandemic had not significantly influenced therapeutic management and short-term outcomes of patients undergoing acute surgical repair of peptic ulcer perforation.

Úlcera marginal perforada post bypass gástrico laparoscópico / Perforated marginal ulcer after laparoscopic gastric bypass

Introduction: Perforated marginal ulcer is a serious event that usually requires reoperation and is associated with morbidity and mortality. Characterization and management of these patients is still debated. Objective: To describe a series of patients subjected to a laparoscopic gastric bypass (LGBP) that evolved with a perforated marginal ulcer. Material and Methods: Records of patients undergoing a LGBP the last 10 years and evolved with a perforated marginal ulcer were retrospectively reviewed. Clinical features, treatment and perioperative morbidity and mortality were analyzed. Results: During this period 2,095 patients were subjected to a LGBP, 12 of them presented a perforated marginal ulcer, corresponding to 10 women and 2 men. Mean age was 39 (21-60) and mean body mass index at the time of initial surgery was 34 (29.3 to 38.6). Ten patients were smoker at the moment of perforation. The occurrence of this happened at a mean of 27 months (range 3-54, median 23.5) after surgery. Eleven cases had a surgical resolution, with a laparoscopic approach in 9 of them and laparotomy on 2. In all cases, a perforated ulcer in the jejunal side of the gastro-jejunal anastomosis was found. There was no mortality or morbidity associated with surgery. Conclusions: In our experience the occurrence of perforated marginal ulcer after a LGBP develops in a small percentage of patients. The laparoscopic approach is of choice, presenting a low morbidity and mortality. Smoking was present in most patients.

Introducción: La perforación de una úlcera marginal es un evento grave que suele requerir una reoperación y se asocia a morbimortalidad. El manejo de estos pacientes es debatido y complejo. Objetivo: Describir una serie de pacientes operados de bypass gástrico laparoscópico (BPGLP) que evolucionaron con una úlcera marginal perforada. Material y Método: Se revisaron retrospectivamente las fichas de pacientes operados de BPGL los últimos 10 años y que evolucionaron con una úlcera marginal perforada. Se analizaron las características clínicas, de tratamiento y morbimortalidad perioperatoria. Resultados: Durante este período se operaron 2.095 pacientes de BPGLP, 12 de los cuales presentaron una úlcera marginal perforada, correspondientes a 10 mujeres y 2 hombres. El promedio de edad fue 39 años (21-60) y el índice de masa corporal (IMC) promedio al momento de la primera cirugía fue 34 (29,3-38,6). Diez pacientes tenían hábito tabáquico activo al momento de la perforación. La ocurrencia de esta sucedió en promedio a los 27 meses (rango 3-54, mediana 23,5) de la cirugía. En 11 casos la resolución fue quirúrgica, mediante abordaje laparoscópico en 9 y laparotomía en 2. En todos los casos se encontró una úlcera perforada en la vertiente yeyunal de la gastro-yeyuno anastomosis. No hubo mortalidad ni morbilidad asociada a la cirugía. Conclusiones: En nuestra experiencia la ocurrencia de úlcera marginal perforada post BPGLP se desarrolla en un bajo porcentaje de pacientes. El abordaje laparoscópico es de elección, presentando una baja morbimortalidad. El hábito tabáquico estuvo presente en la mayoría de los pacientes.

Ulcera perforada post crisis financiera 2002: aumento de incidencia en el Hospital Pasteur / Perforated ulcer subsequent to year 2002 finantial crisis: intensification of incidence at the Hospital Pasteur

Con el objetivo de demostrar el aumento de la incidencia de úlcera gastroduodenal perforada en el Hospital Pasteur y su relación con factores socio económicos, se analizó la frecuencia de esta patología en los últimos 40 meses, así como la evolución de los indicadores socio-económicos que sobrevinieron a partir de la crisis financiera del año 2002. Se operaron 86 pacientes desde 1/2000 hasta 4/2003, 70 (81,4 por ciento) hombres, con una edad promedio de 49 (16-84), destacando un aumento del 83,35 por ciento en el año 2002, respecto del año anterior, lo cual resultó ser estadísticamente significativo. El 36,5 por ciento de los pacientes no presentaba síntomas previos, siendo la perforación el debut de su enfermedad ulcerosa. Se muestra la tendencia negativa de múltiples indicadores socioeconómicos en la misma fecha y basados en la literatura sobre el tema, se demuestra una relación causal entre ambos.

Ulcera perforada post crisis financiera 2002: aumento de incidencia en el Hospital Pasteur / Perforated ulcer subsequent to year 2002 finantial crisis: intensification of incidence at the Hospital Pasteur

Con el objetivo de demostrar el aumento de la incidencia de úlcera gastroduodenal perforada en el Hospital Pasteur y su relación con factores socio económicos, se analizó la frecuencia de esta patología en los últimos 40 meses, así como la evolución de los indicadores socio-económicos que sobrevinieron a partir de la crisis financiera del año 2002. Se operaron 86 pacientes desde 1/2000 hasta 4/2003, 70 (81,4 por ciento) hombres, con una edad promedio de 49 (16-84), destacando un aumento del 83,35 por ciento en el año 2002, respecto del año anterior, lo cual resultó ser estadísticamente significativo. El 36,5 por ciento de los pacientes no presentaba síntomas previos, siendo la perforación el debut de su enfermedad ulcerosa. Se muestra la tendencia negativa de múltiples indicadores socioeconómicos en la misma fecha y basados en la literatura sobre el tema, se demuestra una relación causal entre ambos. (AU)

[Perforated gastric ulcer: an increasing neonatal ICU disease? Report of 4 cases]. / Ulcera gástrica perfurada: doença em ascensão em UTI neonatais? Particularidades neste período e relato de quatro casos.

Between november 1994 and september 1995, there were 4 cases of premature infants in our Neonatal Intensive Care Unit (NICU) who developed gastrointestinal perforation and bleeding due to peptic ulcer and 3 died of this complication. In the first case, the neonate developed pneumoperitonium when weaning from the ventilator and was submitted to the operation with clinical diagnosis of Necrotizing Enterocolitis. Surprisingly, during the procedure, a perforated gastric ulcer was disclosed. Ever since, this NICU is aware of this diagnosis and try to better identify the possible risks factors. Asphyxia, prematurity, stress and situations where low gastrointestinal flow (asphyxia, exchange transfusion, pneumothorax, hemodynamic shock, cardiac arrest) were observed in almost every case. Treatment with dexamethasone or aminophilline was used in 3 of 4 cases and this potential serious side effect should be considered in all babies treated with steroids. The association of ranitidine (2 mg/kg 12/12 h) could not prevent the perforation in cases 1 and 3. Better understanding of physiopathology of the ulcer in this period of life and a effective preventable drug is still lacking.

Ulcera duodenal gigante / Giant duodenal ulcer

Se hace una revisión de la clínica, radiología, endoscopia, pronóstico y tratamiento médico y quirúrgico de la úlcera gigante del duodeno, la forma atípica más severa de la úlcera péptica. Se describe la perfusión continua de antagonistas H-2 de la secreción gástrica y se recomienda su uso previo al procedimiento quirúrgico

[Giant duodenal ulcer]. / Ulcera duodenal gigante.

Giant duodenal ulcers have a high mortality. The clinical, radiological and endoscopic appearance are described. The treatment of choice in patients with giant duodenal ulcer is surgical, the continuous infusion of H-2 blockers is useful before the surgical procedure.

Complicaçöes do divertículo de Meckel / Complications of Meckel's diverticulum

Os autores relatam complicaçöes de divertículo de Meckel encontradas em oito pacientes que foram submetidos a cirurgia abdominal de emergência. O sangramento intestinal esteve presente em um paciente (12,5%), obstruçäo intestinal em três (37,5%) e processo inflamatório agudo em quatro (50,0%). Estas complicaçöes do divertículo manifestaram-se com quadros clínicos diversos e os diganósticos pré-operatórios incluíram abdome agudo obstrutivo em dois (25,0%), obstruçäo intestinal por áscaris em um (12,5), úlcera péptica perfurada em um (12,5), apendicite aguda em três (37,5%) e enterorragia de causa a esclarecer em um (12,5%). Duas complicaçöes foram observadas no pós-operatório. Dentre os pacientes com diverticulite perfurada, houve a necessidade de reoperaçäo para drenagem de abscesso intraperitoneal em um paciente. Outro evoluiu com íleo paralítico prolongado, havendo necessidade de introduçäo de nutriçäo parenteral total. Nenhum paciente faleceu

ABO blood groups, onset age of ulcer symptoms, family history of dyspepsia and complications in duodenal ulcer.

A series of 394 patients with duodenal ulcer was examined to determine the relationship of the blood groups with the age of onset of ulcer symptoms, with the family history of ulcer dyspepsia, and with ulcer complications. It was found that among patients whose symptoms began in the first four decades of life (Group I) there was a significantly larger proportion of blood group A, B, AB subjects and a significantly stronger family history of dyspepsia than among those whose symptoms began from the fifth decade of life (Group II). Group II had a significantly higher proportion of 0 subjects than both Group I and the control population. The mean onset age of patients with blood group 0 was significantly higher than the mean onset age of A, B, AB subjects. These results were uninfluenced by sex. Blood group A, B, AB patients had a significantly higher frequency of positive family history of dyspepsia over blood group 0 patients. The proportion of patients with blood group presenting gastrointestinal bleeding, acute perforation, severe pain, gastroduodenal stenosis or virulent ulcer (multiple, giant or post-bulbar ulcers) was no significantly higher than those blood groups A, B, AB.