peptic ulcer perforation


Summary: Penetration of a PEPTIC ULCER through the wall of DUODENUM or STOMACH allowing the leakage of luminal contents into the PERITONEAL CAVITY.

Top Publications

  1. Hua M, Kong M, Lai M, Luo C. Perforated peptic ulcer in children: a 20-year experience. J Pediatr Gastroenterol Nutr. 2007;45:71-4 pubmed
    ..PPU should be suspected in adolescents who manifest acute abdominal pain and have peritoneal signs. Children with PPU have a more favorable outcome than adults. ..
  2. Kocer B, Surmeli S, Solak C, Unal B, Bozkurt B, Yildirim O, et al. Factors affecting mortality and morbidity in patients with peptic ulcer perforation. J Gastroenterol Hepatol. 2007;22:565-70 pubmed
    ..Therefore, proper resuscitation from shock, improving ASA grade, decreasing delay and reserving definitive surgery for selected patients is needed to improve overall results. ..
  3. Milosavljevic T, Kostic Milosavljevic M, Jovanovic I, Krstic M. Complications of peptic ulcer disease. Dig Dis. 2011;29:491-3 pubmed publisher
    ..Transcatheter arterial embolization is also an effective and safe treatment in patients with duodenal ulcers re-bleeding after therapeutic endoscopy or surgery. ..
  4. Møller M, Adamsen S, Wøjdemann M, Møller A. Perforated peptic ulcer: how to improve outcome?. Scand J Gastroenterol. 2009;44:15-22 pubmed publisher
    ..emergency surgery for perforated peptic ulcer and the mortality rate for patients undergoing surgery for peptic ulcer perforation have increased. This increase has occurred despite improvements in perioperative treatment and monitoring...
  5. Christiansen C, Christensen S, Riis A, Thomsen R, Johnsen S, Tonnesen E, et al. Antipsychotic drugs and short-term mortality after peptic ulcer perforation: a population-based cohort study. Aliment Pharmacol Ther. 2008;28:895-902 pubmed publisher
    b>Peptic ulcer perforation is a serious surgical emergency with a substantial short-term mortality, but the influence of antipsychotic drug use on the prognosis remains unknown...
  6. Palanivelu C, Jani K, Senthilnathan P. Laparoscopic management of duodenal ulcer perforation: is it advantageous?. Indian J Gastroenterol. 2007;26:64-6 pubmed
    ..The mean postoperative hospital stay was 5.8 days. Results of laparoscopic management of perforated peptic ulcer are encouraging, with no conversion to open surgery, low morbidity and no mortality. ..
  7. Lunevicius R, Morkevicius M. Risk factors influencing the early outcome results after laparoscopic repair of perforated duodenal ulcer and their predictive value. Langenbecks Arch Surg. 2005;390:413-20 pubmed
    ..039, t test). Ulcer perforation size of >8 mm is a significant risk factor influencing the conversion rate. An increase in the suture leakage rate is predicted by delayed presentation of >9 h. ..
  8. Arnaud J, Tuech J, Bergamaschi R, Pessaux P, Regenet N. Laparoscopic suture closure of perforated duodenal peptic ulcer. Surg Laparosc Endosc Percutan Tech. 2002;12:145-7 pubmed
    ..The results of our study show the feasibility of the laparoscopic approach for perforated peptic ulcer repair, with acceptable mortality and morbidity rates. ..
  9. Hemmer P, de Schipper J, van Etten B, Pierie J, Bonenkamp J, de Graaf P, et al. Results of surgery for perforated gastroduodenal ulcers in a Dutch population. Dig Surg. 2011;28:360-6 pubmed publisher
    ..Finding that shock, tachycardia and anemia are independently associated with 30-day mortality could indicate that patients are septic upon admission. Improvements in survival might be achieved by early sepsis treatment. ..

More Information


  1. Vaidya B, Garg C, Shah J. Laparoscopic repair of perforated peptic ulcer with delayed presentation. J Laparoendosc Adv Surg Tech A. 2009;19:153-6 pubmed publisher
    ..Laparoscopic repair of perforated peptic ulcer is a safe, reliable procedure even in delayed presentations with peritonitis. It has an acceptable morbidity and all the advantages of the minimally invasive surgical approach. ..
  2. Seelig M, Seelig S, Behr C, Schönleben K. Comparison between open and laparoscopic technique in the management of perforated gastroduodenal ulcers. J Clin Gastroenterol. 2003;37:226-9 pubmed
    ..2 vs. 4 dosages; P = 0.04). Laparoscopic treatment of perforated gastroduodenal ulcers is an effective treatment option and should be considered in suited patients for the initial approach. ..
  3. Lau H. Laparoscopic repair of perforated peptic ulcer: a meta-analysis. Surg Endosc. 2004;18:1013-21 pubmed
    ..This approach is as safe and effective as open repair. Laparoscopic Graham-Steele patch repair of perforated duodenal or justapyloric ulcer is beneficial for patients without Boey's risk factors. ..
  4. Egberts J, Summa B, Schulz U, Schafmayer C, Hinz S, Tepel J. Impact of preoperative physiological risk profile on postoperative morbidity and mortality after emergency operation of complicated peptic ulcer disease. World J Surg. 2007;31:1449-57 pubmed
    ..Prospective studies are needed to prove its applicability for adjusting treatment to individual patients. ..
  5. Møller M, Engebjerg M, Adamsen S, Bendix J, Thomsen R. The Peptic Ulcer Perforation (PULP) score: a predictor of mortality following peptic ulcer perforation. A cohort study. Acta Anaesthesiol Scand. 2012;56:655-62 pubmed publisher
    ..A total of 708 patients (27%) died within 30 days of surgery. The Peptic Ulcer Perforation (PULP) score - comprised eight variables with an adjusted odds ratio of more than 1...
  6. Siu W, Chau C, Law B, Tang C, Ha P, Li M. Routine use of laparoscopic repair for perforated peptic ulcer. Br J Surg. 2004;91:481-4 pubmed
    ..Laparoscopic repair of perforated peptic ulcer is a safe emergency procedure in routine clinical practice for patients with perforated pyloroduodenal ulcer. ..
  7. Mishra A, Sharma D, Raina V. A simplified prognostic scoring system for peptic ulcer perforation in developing countries. Indian J Gastroenterol. 2003;22:49-53 pubmed
    ..The Jabalpur scoring system is effective for prognostication in cases of peptic perforation. It is simple and user-friendly as it uses only six routinely documented clinical risk factors. ..
  8. Lal P, Vindal A, Hadke N. Controlled tube duodenostomy in the management of giant duodenal ulcer perforation: a new technique for a surgically challenging condition. Am J Surg. 2009;198:319-23 pubmed publisher
    ..Based on the ease of the technique and the high success of the procedure in our experience in this select group, we recommend this procedure for the management of GDU perforation as a safe, reliable, and easy technique to learn. ..
  9. Garcia Rodriguez L, Barreales Tolosa L. Risk of upper gastrointestinal complications among users of traditional NSAIDs and COXIBs in the general population. Gastroenterology. 2007;132:498-506 pubmed
    ..Whether use of selective inhibitors of cyclooxygenase-2 (COXIBs) will translate into a clinically relevant reduced toxicity has not been widely investigated in the general population...
  10. Vonkeman H, Fernandes R, van der Palen J, van Roon E, van de Laar M. Proton-pump inhibitors are associated with a reduced risk for bleeding and perforated gastroduodenal ulcers attributable to non-steroidal anti-inflammatory drugs: a nested case-control study. Arthritis Res Ther. 2007;9:R52 pubmed
    ..17 to 0.67; p = 0.002). Especially at risk for NSAID ulcer complications are elderly patients with cardiovascular co-morbidity. Proton-pump inhibitors are associated with a reduced risk for NSAID ulcer complications. ..
  11. Canoy D, Hart A, Todd C. Epidemiology of duodenal ulcer perforation: a study on hospital admissions in Norfolk, United Kingdom. Dig Liver Dis. 2002;34:322-7 pubmed
    ..Furthermore, the difference in age distribution of incident cases between males and females may explain the higher mortality in females. ..
  12. Rajesh V, Chandra S, Smile S. Risk factors predicting operative mortality in perforated peptic ulcer disease. Trop Gastroenterol. 2003;24:148-50 pubmed
    ..This study was undertaken to review the factors which determine mortality following emergency surgery for peptic ulcer perforation. A prospective study of all patients who underwent surgery at our institute for peptic ulcer perforation ..
  13. Lam C, Yuen A, Chik B, Wai A, Fan S. Laparoscopic surgery for common surgical emergencies: a population-based study. Surg Endosc. 2005;19:774-9 pubmed
    ..However, there was also a wide variation in the diffusion rate among the 14 HA hospitals. Efforts to reduce hospital variation for the better dissemination of safe laparoscopic technique may be warranted. ..
  14. Kumar K, Pai D, Srinivasan K, Jagdish S, Ananthakrishnan N. Factors contributing to releak after surgical closure of perforated duodenal ulcer by Graham's Patch. Trop Gastroenterol. 2002;23:190-2 pubmed
    ..6% (5 out of 9 patients) compared to 2.7% (3 out of 110 patients) in the control group [p-0.0001]. Releak was a significant factor influencing mortality rate after omental patch closure of perforated duodenal ulcer. ..
  15. Arveen S, Jagdish S, Kadambari D. Perforated peptic ulcer in South India: an institutional perspective. World J Surg. 2009;33:1600-4 pubmed publisher
    ..Decreasing the delay in intervention and improving access to medical care may improve the outcome of patients undergoing surgery for perforated peptic ulcer. High-risk patients are those who present with shock and co-morbid illness. ..
  16. Lunevicius R, Morkevicius M. Management strategies, early results, benefits, and risk factors of laparoscopic repair of perforated peptic ulcer. World J Surg. 2005;29:1299-310 pubmed
    ..Inadequate ulcer localization, large perforation size (defined by some as > 6 mm diameter, and by others as > 10 mm), and ulcers with friable edges are also considered as conversion risk factors. ..
  17. Møller M, Adamsen S, Thomsen R, Møller A. Preoperative prognostic factors for mortality in peptic ulcer perforation: a systematic review. Scand J Gastroenterol. 2010;45:785-805 pubmed publisher
    ..In patients with PPU, a number of negative prognostic factors can be identified prior to surgery, and many of these seem to be related to presence of the sepsis syndrome. ..
  18. Christensen S, Riis A, Nørgaard M, Thomsen R, Tønnesen E, Larsson A, et al. Perforated peptic ulcer: use of pre-admission oral glucocorticoids and 30-day mortality. Aliment Pharmacol Ther. 2006;23:45-52 pubmed
    ..ulcer disease, limited data exist on how use of oral glucocorticoids affects outcome for patients with peptic ulcer perforation. To examine 30-day mortality from peptic ulcer perforation among pre-admission oral glucocorticoid users ..
  19. Testini M, Portincasa P, Piccinni G, Lissidini G, Pellegrini F, Greco L. Significant factors associated with fatal outcome in emergency open surgery for perforated peptic ulcer. World J Gastroenterol. 2003;9:2338-40 pubmed
  20. Kujath P, Schwandner O, Bruch H. Morbidity and mortality of perforated peptic gastroduodenal ulcer following emergency surgery. Langenbecks Arch Surg. 2002;387:298-302 pubmed
    ..Data from 102 patients who underwent emergency surgery for peptic ulcer perforation were recorded prospectively...
  21. Hermansson M, Ekedahl A, Ranstam J, Zilling T. Decreasing incidence of peptic ulcer complications after the introduction of the proton pump inhibitors, a study of the Swedish population from 1974-2002. BMC Gastroenterol. 2009;9:25 pubmed publisher
    ..Sales of prescribed NSAID/ASA increased, especially in middle-aged and elderly women. This fact seems to have had little effect on the incidence of peptic ulcer complications. ..
  22. Møller M, Shah K, Bendix J, Jensen A, Zimmermann Nielsen E, Adamsen S, et al. Risk factors in patients surgically treated for peptic ulcer perforation. Scand J Gastroenterol. 2009;44:145-52, 2 p following 152 pubmed publisher
    ..been added to the list of independent risk factors for death within 30 days of surgery in patients with peptic ulcer perforation. Finding that shock upon admission, reduced albumin blood levels upon admission, renal insufficiency upon ..
  23. Barut I, Tarhan O, Cerci C, Karaguzel N, Akdeniz Y, Bulbul M. Prognostic factors of peptic ulcer perforation. Saudi Med J. 2005;26:1255-9 pubmed
    ..Thus, such factors need to be carefully taken into account during the general workup of patients admitted for PPU. ..
  24. Thorsen K, Glomsaker T, von Meer A, Søreide K, Søreide J. Trends in diagnosis and surgical management of patients with perforated peptic ulcer. J Gastrointest Surg. 2011;15:1329-35 pubmed publisher
    ..This study demonstrates an increased use of CT as the primary diagnostic tool for PPU and of laparoscopic repair in its surgical treatment. These changes in management are not associated with altered outcomes. ..
  25. Forsmo H, Glomsaker T, Vandvik P. [Perforated peptic ulcer--a 12-year material]. Tidsskr Nor Laegeforen. 2005;125:1822-4 pubmed
    ..2; 95 % CI 1.7 - 10.2; p = 0.002). Perforated peptic ulcer is a disease with low incidence, high mortality and a high frequency of postoperative complications, mainly determined by the patient's age and ASA classification. ..
  26. Kamani F, Moghimi M, Marashi S, Peyrovi H, Sheikhvatan M. Perforated peptic ulcer disease: mid-term outcome among Iranian population. Turk J Gastroenterol. 2010;21:125-8 pubmed
  27. Lau J, Sung J, Hill C, Henderson C, Howden C, Metz D. Systematic review of the epidemiology of complicated peptic ulcer disease: incidence, recurrence, risk factors and mortality. Digestion. 2011;84:102-13 pubmed publisher
    ..Older age, comorbidity, shock and delayed treatment were associated with increased mortality. Complicated peptic ulcer remains a substantial healthcare problem which places patients at a high risk of recurrent complications and death. ..
  28. Gupta S, Kaushik R, Sharma R, Attri A. The management of large perforations of duodenal ulcers. BMC Surg. 2005;5:15 pubmed
    ..The word 'giant' should be reserved for perforations that exceed 3 cms in diameter, and these are extremely uncommon. ..
  29. Kuwabara K, Matsuda S, Fushimi K, Ishikawa K, Horiguchi H, Fujimori K. Community-based evaluation of laparoscopic versus open simple closure of perforated peptic ulcers. World J Surg. 2011;35:2485-92 pubmed publisher
    ..Because longer OR time was associated with more frequent complications and ventilation, surgeons should obtain the skills and strategies necessary to accomplish LSC without extending OR time improperly. ..
  30. Ates M, Coban S, Sevil S, Terzi A. The efficacy of laparoscopic surgery in patients with peritonitis. Surg Laparosc Endosc Percutan Tech. 2008;18:453-6 pubmed publisher
    ..This technique can be widely used in abdominal emergencies with increasing experience, but further studies are required to definitively establish its role in acute abdominal disorders. ..
  31. Tomtitchong P, Siribumrungwong B, Vilaichone R, Kasetsuwan P, Matsukura N, Chaiyakunapruk N. Systematic review and meta-analysis: Helicobacter pylori eradication therapy after simple closure of perforated duodenal ulcer. Helicobacter. 2012;17:148-52 pubmed publisher
    ..All duodenal ulcer perforation patients should be tested for H. pylori infection, and eradication therapy is required in all infected patients. ..
  32. Koc M, Yoldas O, Kilic Y, Gocmen E, Ertan T, Dizen H, et al. Comparison and validation of scoring systems in a cohort of patients treated for perforated peptic ulcer. Langenbecks Arch Surg. 2007;392:581-5 pubmed
    ..Results also indicate the importance of maintenance of systemic perfusion of the patient at the early phases of peptic ulcer perforation.
  33. Alvarado Aparicio H, Moreno Portillo M. Multimedia article: management of duodenal ulcer perforation with combined laparoscopic and endoscopic methods. Surg Endosc. 2004;18:1394 pubmed
  34. Malkov I, Zaynutdinov A, Veliyev N, Tagirov M, Merrell R. Laparoscopic and endoscopic management of perforated duodenal ulcers. J Am Coll Surg. 2004;198:352-5 pubmed
    ..Endoscopic/laparoscopic repair of perforated duodenal ulcers is a safe and effective surgical tactic if followed by treatment for Helicobacter pylori. ..
  35. Christensen S, Riis A, Nørgaard M, Thomsen R, Sørensen H. Introduction of newer selective cyclo-oxygenase-2 inhibitors and rates of hospitalization with bleeding and perforated peptic ulcer. Aliment Pharmacol Ther. 2007;25:907-12 pubmed
  36. Thomsen R, Riis A, Christensen S, Nørgaard M, Sørensen H. Diabetes and 30-day mortality from peptic ulcer bleeding and perforation: a Danish population-based cohort study. Diabetes Care. 2006;29:805-10 pubmed
    ..51 (1.15-1.98). Among patients with peptic ulcer bleeding and perforation, diabetes appears to be associated with substantially increased short-term mortality. ..
  37. Rahman M, Islam M, Flora S, Akhter S, Hossain S, Karim F. Mortality in perforated peptic ulcer patients after selective management of stratified poor risk cases. World J Surg. 2007;31:2341-4; discussion 2345-6 pubmed
    ..5%. Minimal surgical intervention (percutaneous peritoneal drainage) can significantly lower the mortality rate among a selected group of critically ill, poor risk patients with perforated peptic ulcer disease. ..
  38. Edwards M, Kollenberg S, Brandt M, Wesson D, Nuchtern J, Minifee P, et al. Surgery for peptic ulcer disease in children in the post-histamine2-blocker era. J Pediatr Surg. 2005;40:850-4 pubmed
    ..Effective prophylaxis of children receiving steroids and nonsteroidal antiinflammatory drugs may play a role in decreasing the risk of PUD. ..
  39. Montalvo Javé E, Corres Sillas O, Athie Gutiérrez C. Factors associated with postoperative complications and mortality in perforated peptic ulcer. Cir Cir. 2011;79:141-8 pubmed
    ..8 days. The presence of early postoperative complications is associated with time of onset of abdominal pain before admission, abdominal distension, blood type O positive and the presence of septic shock on admission. ..
  40. Larkin J, Bourke M, Muhammed A, Waldron R, Barry K, Eustace P. Mortality in perforated duodenal ulcer depends upon pre-operative risk: a retrospective 10-year study. Ir J Med Sci. 2010;179:545-9 pubmed publisher
    ..Given that mortality is equivalent between ASA IV/V patients whether managed operatively or conservatively, we suggest that both management options are equally justifiable. ..
  41. Sommer T, Elbroend H, Friis Andersen H. Laparoscopic repair of perforated ulcer in Western Denmark - a retrospective study. Scand J Surg. 2010;99:119-21 pubmed
    ..laparoscopic repair of perforated ulcer was done without any selection criteria in few surgical departments in Western Denmark and was associated with a low mortality but a higher risk of reperforation. ..
  42. Paimela H, Oksala N, Kivilaakso E. Surgery for peptic ulcer today. A study on the incidence, methods and mortality in surgery for peptic ulcer in Finland between 1987 and 1999. Dig Surg. 2004;21:185-91 pubmed
    ..Local procedures are overwhelmingly applied in emergency surgery and more extensive surgery is unnecessary. Nevertheless, the overall surgical mortality remained 8% between 1987 and 1999. ..
  43. Lanas A, Garcia Rodriguez L, Polo Tomas M, Ponce M, Alonso Abreu I, Perez Aisa M, et al. Time trends and impact of upper and lower gastrointestinal bleeding and perforation in clinical practice. Am J Gastroenterol. 2009;104:1633-41 pubmed publisher
  44. Bertleff M, Lange J. Perforated peptic ulcer disease: a review of history and treatment. Dig Surg. 2010;27:161-9 pubmed publisher
    ..Laparoscopic correction of PPU as well as for definitive ulcer surgery has many advantages. Surgery for PPU is still a subject of debate despite more than an era of published expertise, indicating the need for establishing guidelines. ..
  45. Lunevicius R, Morkevicius M. Systematic review comparing laparoscopic and open repair for perforated peptic ulcer. Br J Surg. 2005;92:1195-207 pubmed
    ..However, limited knowledge about its benefits and risks compared with open repair suggests that the latter, more familiar, approach may be more appropriate in high-risk patients. Further studies are needed. ..
  46. Lohsiriwat V, Prapasrivorakul S, Lohsiriwat D. Perforated peptic ulcer: clinical presentation, surgical outcomes, and the accuracy of the Boey scoring system in predicting postoperative morbidity and mortality. World J Surg. 2009;33:80-5 pubmed publisher
    ..Perforated peptic ulcer is associated with high rates of mortality and morbidity. The Boey risk score serves as a simple and precise predictor for postoperative mortality and morbidity. ..
  47. Kumar D, Sinha A. Helicobacter pylori infection delays ulcer healing in patients operated on for perforated duodenal ulcer. Indian J Gastroenterol. 2002;21:19-22 pubmed
    ..pylori infection was the only significant factor responsible for persistence of ulcer after surgery. We advocate H. pylori eradication therapy in patients operated on for perforated duodenal ulcer. ..
  48. Torab F, Amer M, Abu Zidan F, Branicki F. Perforated peptic ulcer: different ethnic, climatic and fasting risk factors for morbidity in Al-ain medical district, United Arab Emirates. Asian J Surg. 2009;32:95-101 pubmed publisher
    ..Patients with dyspeptic symptoms and a history of previous PUD should be considered for prophylactic treatment to prevent ulcer recurrence during prolonged daytime fasting in Ramadan, especially during the winter time. ..
  49. Lagoo S, McMahon R, Kakihara M, Pappas T, Eubanks S. The sixth decision regarding perforated duodenal ulcer. JSLS. 2002;6:359-68 pubmed
  50. Gisbert J, Pajares J. Helicobacter pylori infection and perforated peptic ulcer prevalence of the infection and role of antimicrobial treatment. Helicobacter. 2003;8:159-67 pubmed
    ..Recurrent ulcer disease after peptic ulcer perforation mainly occurs in patients with H...
  51. Bertleff M, Halm J, Bemelman W, van der Ham A, van der Harst E, Oei H, et al. Randomized clinical trial of laparoscopic versus open repair of the perforated peptic ulcer: the LAMA Trial. World J Surg. 2009;33:1368-73 pubmed publisher
    ..5 days in the laparoscopic group versus 8.0 days in the open group (P = 0.235). Laparoscopic repair of PPU is a safe procedure compared with open repair. The results considering postoperative pain favor the laparoscopic procedure. ..
  52. Kung S. Teflon-felt grafting of giant gastroduodenal perforation in a canine model. Surg Today. 2004;34:145-9 pubmed
    ..Teflon-felt appears to be a viable alternative for the delayed repair of giant ulcer perforation. ..
  53. Lee K, Chang H, Lo C. Endoscope-assisted laparoscopic repair of perforated peptic ulcers. Am Surg. 2004;70:352-6 pubmed
    ..We conclude that endoscope-assisted laparoscopic repair for PPU is safe and effective. This revised technique allows surgeons to exclude patients who are likely to fail the laparoscopic repair. ..