Epidemiology and treatment of perforated duodenal ulcer in Kemerovo Region

Aim. To estimate the frequency of ulcerative bleeding, pyloric stenosis, need for pyloroplasty and the justification of vagotomy for perforated duodenal ulcer.

Materials and Methods. We analyzed the surgical treatment of patients with perforated duodenal ulcer admitted to Podgorbunskiy Regional Clinical Emergency Hospital during 1999-2019.

Results. In 2018, the number of surgical interventions due to perforated duodenal ulcer decreased by 56.4% in comparison with 1998. In 8.6% and 2.1% of patients, perforated duodenal ulcer was combined with pyloric stenosis and bleeding, respectively, requiring Judd pyloroplasty (diamond- shaped transverse excision) or gastroduodenotomy followed by Heineke-Mikulicz pyloroplasty (transversely closed longitudinal incision across the pylorus) and vagotomy. Distal gastric resection by Billroth’s operation II was required in 2.8% of patients. Repeated admission of patients with duodenal ulcer complications has been observed after isolated suturing of perforated duodenal ulcer.

Conclusion. Over the last 20 years, the amount of surgical interventions because of perforated duodenal ulcer in Kemerovo Region decreased more than twofold. In > 10% patients, pyloric stenosis and bleeding require a gastric drainage. In > 8% patients, perforated duodenal ulcer is combined with pyloric stenosis; in these cases, Heineke-Mikulicz pyloroplasty may be a treatment of choice. In > 2% patients, perforated duodenal ulcer is combined with ulcerative bleeding requiring excision of the ulcer and optional distal gastric resection. Pyloroplasty may be combined with vagotomy to normalise the proteolytic activity of gastric acid.

1. Chung KT, Shelat VG. Perforated peptic ulcer - an update. World J Gastrointest Surg. 2017;9(1):1-12. https://doi.org/10.4240/wjgs.v9.i1.1

2. Zelickson MS, Bronder CM, Johnson BL, Camunas JA, Smith DE, Rawlinson D, Von S, Stone HH, Taylor SM. Helicobacter pylori is not the predominant etiology for peptic ulcers requiring operation. Am Surg. 2011;77(8):1054-1060.

3. Bertleff MJ, Lange JF. Perforated peptic ulcer disease: a review of history and treatment. Dig Surg. 2010;27(3):161-169. https://doi.org/10.1159/000264653

4. Lau JY, Sung J, Hill C, Henderson C, Howden CW, Metz DC. Systematic review of the epidemiology of complicated peptic ulcer disease: incidence, recurrence, risk factors and mortality. Digestion. 2011;84(2):102-113. https://doi.org/10.1159/000323958

5. Grišin E, Mikalauskas S, Poškus T, Йотаутас V, Strupas K. Laparoscopicpyloroplasty for perforated peptic ulcer. Wideochirurgiai Inne Tech Maloinwazyjne. 2017;12(3):311-314. https://doi.org/10.5114/wiitm.2017.68537

6. Lau JY, Sung J, Hill C, Henderson C, Howden CW, Metz DC. Systematic review of the epidemiology of complicated peptic ulcer disease: incidence, recurrence, risk factors and mortality. Digestion. 2011;84(2):102-113. https://doi.org/10.1159/000323958

7. Podoluzhnyi VI. Current concepts of etiology, diagnosis, and surgical treatment of perforated duodenal ulcer. Fundamental and clinical medicin. 2019;4(1):73-79. (In Russ.) https://doi.org/10.23946/2500-0764-2019-4-1-73-79

8. Bornman PC, Theodorou NA, Jeffery PC, Marks IN, Essel HP, Wright JP, Terblanche J. Simple closure of perforated duodenal ulcer: a prospective evaluation of a conservative management policy. Br J Surg. 1990;77(1):73-75. https://doi.org/10.1002/bjs.1800770126

9. Afendulov SA, Smirnov AD, Zhuravlyov GYu. Rehabilitation of patients after the suturing of perforated gastroduodena ulcer. Surgery. 2002;(4):48-51. (In Russ.)

10. Gisbert JP, Pajares JM. Helicobacter pylori infection and perforated peptic ulcer prevalence of the infection and role of antimicrobial treatment. Helicobacter. 2003;8(3):159-167. https://doi.org/10.1046/j.1523-5378.2003.00139.x

11. Yang YJ, Bang CS, Shin SP, Park TY, Suk KT, Baik GH, , Kim DJ, et al. Clinical characteristics of peptic ulcer perforation in Korea. World J Gastroenterol. 2017;23(14):2566-2574. https://doi.org/10.3748/wjg.v23.i14.2566

12. Podoluzhnyy VI, Ivanov SV, Grekov DN, Oorzhak OV. Probodnaya piloroduodenal'naya yazva. Kemerovo; 2014. (In Russ.)

13. Krasnov OA, Grekov DN, Podoluzhny VI, Pavlenko VV, Oorzhak OV. Experimental and clinical grounds for using 30% solution of ethyl alcohol for chemical denervation of the gastric acid-producing zone. Grekov's bulletin of surgery. 2007;166(5):39-43 (In Russ.)

14. Budzyński P, Pędziwiatr M, Grzesiak-Kuik A, Natkaniec M, Major P, Matłok M, Stanek M, Wierdak M, Migaczewski M, Pisarska M, Budzyński A. Changing patterns in the surgical treatment of perforated duodenal ulcer — single centre experience. Videosurgery and Other Miniinvasive Techniques. 2015;10(3):430-436. https://doi.org/10.5114/wiitm.2015.54057

15. Rigopoulos A, Ramboiu S, Georgescu I. A critical Evaluation of Surgical Treatment of Perforated Ulcer. Curr Health Sci J. 2011;37(2):75-8.

16. Kamani F, Moghimi M, Marashi SA, Peyrovi H, Sheikhvatan M. Perforated peptic ulcer disease: mid-term outcome among Iranian population. Turk J Gastroenterol. 2010;21:125-128. https://doi.org/10.4318 / tjg.2010.0069

17. Grišin E, Mikalauskas S, Poškus T, Jotautas V, Strupas K. Laparoscopic pyloroplasty for perforated peptic ulcer. Videosurgery and Other Miniinvasive Techniques. 2017;12(3):311-314. https://doi.org/10.5114/wiitm.2017.68537

18. Avakimyan VA, Karapidi GK, Avakimyan SV, Alukhanyan OA, Didigov MT. Combination of perforation and hemorrhage accompanying gastroduodenal ulcer. Kuban Scientific Medical Bulletin. 2017;6:7-11. (In Russ.) Available at: https://doi.org/10.25207/1608-6228-2017-24-6-7-11. Accessed: April 24, 2020.