Group A patients were younger (t test, P = 0.01) and more likely to present with perforation, whereas patients in group B presented with a combination of symptoms (chi square, P = 0.03). [ncbi.nlm.nih.gov]

• Fever

  The video shows the management of a 51-year-old woman who came to the emergency room with acute abdomen, leukocytosis, and fever. Laparoscopy showed peritonitis with apparent gastric perforation. Duodenal perforation was confirmed by endoscopy. [ncbi.nlm.nih.gov]

  Case 2 A 11-month-old male child was admitted with 10 days history of fever, rashes, and vesicular eruptions over the body, and a probable diagnosis of measles was made. [afrjpaedsurg.org]

  A 55-year-old man presented after 3 weeks of sharp epigastric pain radiating to the right upper quadrant, fever, and generalized weakness. He had a history of significant heroin and cocaine abuse and was currently in a methadone maintenance program. [mdedge.com]

  In addition, other diagnostic tools include temperature measurement as elevated fevers are common and blood pressure monitoring because a drop in blood pressure is not uncommon for the affected. [stomachbloating.net]

  Abstract We wish to report a 14-year-old male adolescent who presented with sudden onset epigastric followed by right sided abdominal pain, vomiting and fever. [jpss.eu]

• Severe Pain

  The most common sign of the deadly condition is a sudden and severe pain in your abdomen. This pain will steadily get worse. If you experience this kind of pain it is vital to see your GP as soon as possible, or dial NHS 111. [thesun.co.uk]

  I had a duodenal ulcer and didn't know it...not until it ruptured and I experienced the worst pain of my life. And I've had several surgeries and given birth! [patient.info]

  The chemical peritonitis due to efflux of gastroduodenal contents and severe pain lead to tachycardia. The classic triad of sudden onset of abdominal pain, tachycardia and abdominal rigidity is the hallmark of PPU. [wjgnet.com]

  All patients came with complains of severe pain in abdomen. The pain was associated with multiple episodes of non-bilious vomiting. Surprisingly none of them presented with fever. [webmedcentral.com]

  Free peritoneal perforation and resulting chemical and bacterial peritonitis is a surgical emergency causing sudden, rapidly spreading, severe upper abdominal pain exacerbated by movement; the pain may radiate to the right lower abdomen or to both shoulders [aafp.org]

• Abdominal Pain

  We report a case of a 30-year-old male patient with abdominal pain and respiratory distress. Resulting from physical examination and laboratory data of the patient, acute abdomen and pneumothorax were diagnosed simultaneously. [ncbi.nlm.nih.gov]

  Abstract We wish to report a 14-year-old male adolescent who presented with sudden onset epigastric followed by right sided abdominal pain, vomiting and fever. [jpss.eu]

  These patients may have epigastric discomfort, but they do not present with acute abdominal pain. Or peptic ulcers can erode through the mucosa to cause a bowel perforation. [ole.bris.ac.uk]

  The history, obtained from his family, was that he had been seized with severe upper-abdominal pain while walking from one room to another in his home 12 hours previously, and that he had collapsed immediately. [annals.org]

• Epigastric Pain

  Figure 1 A 48-year-old man who was receiving medical treatment for peptic ulcer disease experienced intense epigastric pain, sudden in onset and without emesis, four hours before admission. [nejm.org]

  Links: haematemesis right upper quadrant pain right iliac fossa pain (RIF) epigastric pain [gpnotebook.co.uk]

  Critical Essential Core Tested Community Questions (3) (M2.GI.13) A 75-year-old male presents with a 1-month history of severe abdominal and epigastric pain. [medbullets.com]

  References: [12] Pathophysiology Clinical features Gastric ulcer Duodenal ulcer Findings common to both Dyspepsia : postprandial heaviness, early satiety, and gnawing, aching or burning epigastric pain Pain relief with antacids Potential signs of internal [amboss.com]

  A 55-year-old man presented after 3 weeks of sharp epigastric pain radiating to the right upper quadrant, fever, and generalized weakness. He had a history of significant heroin and cocaine abuse and was currently in a methadone maintenance program. [mdedge.com]

• Acute Abdomen

  Pneumothorax and pneumomediastinum are rarely observed as a complication of perforated peptic ulcer, which is a common cause of acute abdomen. We report a case of a 30-year-old male patient with abdominal pain and respiratory distress. [ncbi.nlm.nih.gov]

  acute abdomen following medical conditions which require frequent use of NSAID therapy. 1. [afrjpaedsurg.org]

  Although sonography is useful as a first-line diagnostic tool for acute abdomen in the emergency department, it is less helpful in the diagnosis of peptic ulcer perforation. [academic.oup.com]

  Perforated ulcers usually present with an acute abdomen and are life-threatening unless immediately recognized and treated. [mdedge.com]

• Abdominal Distension

  Acute ulcer in the neonate may develop with prematurity, anoxia, abdominal distension, or hyperacidity. [afrjpaedsurg.org]

  Eight (61.54%) patients were having guarding / rigidity and four(30.77%) patients presented with abdominal distension. [webmedcentral.com]

  In the third phase (more than 12 h), abdominal distension, pyrexia and hypotension with acute circulatory collapse may be evident. [wjgnet.com]

• Abdominal Tenderness

  Spillage of digestive contents into the abdominal cavity due to a perforated ulcer provokes intense inflammation of the area. This leads to not only pain but abdominal tenderness, meaning touching or pressing on the abdomen provokes increased pain. [livestrong.com]

  Typical signs such as abdominal rigidity and right lower quadrant tenderness (as a result of fluid tracking along the right paracolic gutter) may be seen. [wjgnet.com]

  Generalized abdominal tenderness, rebound tenderness, board-like abdominal wall rigidity, and hypoactive bowel sounds (clinical signs of peritonitis) may be masked in older patients and those taking steroids, immunosuppressants, or narcotic analgesics [aafp.org]

• Hypotension

  Fever, hypotension, and oliguria suggest sepsis and circulatory compromise. [aafp.org]

  Other factors such as shock (hypotension) and comorbidities have also been described as factors contributing to poor response to conservative approach, as well as associated with higher mortality [5-6]. [cureus.com]

  Hypotension, tachycardia or high fever are signs of gravity. [omicsonline.org]

  Patients with bleeding ulcers may report passage of black tarry stools (melena), weakness, a sense of light-headedness or ay even pass out upon standing ( orthostatic hypotension or syncope ) and vomiting blood (hematemesis). [medicinenet.com]

  In the third phase (more than 12 h), abdominal distension, pyrexia and hypotension with acute circulatory collapse may be evident. [wjgnet.com]

• Tachycardia

  On examination: patient looks ill and lies unusually still in pain tachycardia shallow respiration Inspection: abdomen is flat - does not fall and rise with respiration Palpation: very tender, intense guarding & "board-like" rigidity Percussion: if air [gpnotebook.co.uk]

  Pain was the consistent symptom while tachycardia, tenderness, and guarding were the signs present in all 70 (40%) patients. Gas under diaphragm (pneumoperitoneum) was found in 67 (95.71%). [scopemed.org]

  On examination the child was dehydrated, anicteric, had tachycardia and tachypnoea. Abdominal examination revealed guarding and rebound tenderness suggestive of perforation peritonitis. [afrjpaedsurg.org]

  The chemical peritonitis due to efflux of gastroduodenal contents and severe pain lead to tachycardia. The classic triad of sudden onset of abdominal pain, tachycardia and abdominal rigidity is the hallmark of PPU. [wjgnet.com]

  Then presence of clinical features pain, vomiting, fever, abdominal distension, tenderness, guarding / rigidity, tachycardia, shock were recorded. [webmedcentral.com]

His workup revealed an elevated white blood cell count, gallstones, gallbladder wall thickening and pericholecystic fluid on his right upper quadrant ultrasound, and an upright chest xray without free air. [sages.org]

After a brief history and physical examination in the emergency room, the patient was admitted and a thorough workup panel was requested. [cureus.com]

Victims of penetrating trauma with signs of peritonitis require surgical exploration without further diagnostic workup. [wjes.biomedcentral.com]

• Pneumoperitoneum

  A chest film (Panel A) showed bilateral pneumoperitoneum (arrows). An exploratory laparotomy revealed a perforated duodenal ulcer with callous borders (Panel B). [nejm.org]

  Gas under diaphragm (pneumoperitoneum) was found in 67 (95.71%). [scopemed.org]

  Switch off gas when desired pneumoperitoneum is created & remove the Veress needle Port location A 10mm camera port is placed in the umbilicus; this position will vary according the build of the patient. [laparoscopyhospital.com]

  A perforated peptic ulcer is the first differential diagnosis of pneumoperitoneum, but in the socio-epidemiological context of Togo, one should also consider typhoid. [medical-dictionary.thefreedictionary.com]

  The abdominal radiograph showed football sign and upright chest radiograph confirmed pneumoperitoneum. At laparoscopy duodenal ulcer perforation was diagnosed. [jpss.eu]

Simple closure, with or without H2 antagonist treatment, was the most popular management of a perforated acute duodenal ulcer. [ncbi.nlm.nih.gov]

CONCLUSION: Early management in the intensive care unit and appropriate surgical intervention maximised the patient's chances of survival despite the poor prognosis associated with her dual pathology. [ncbi.nlm.nih.gov]

[…] medical therapy hemorrhage / perforation Zollinger-Ellison syndrome truly refractory cases consider an parietal cell vagotomy surgical approaches include: Billroth II (antrectomy with gastrojejunostomy) low recurrence but high rate of dumping syndrome Prognosis [medbullets.com]

Prognosis of gastric cancer stays dependent on tumour stage and seems not to be worsened by the perforation itself. Postoperative pain and rate of wound infections are lower after laparoscopic operation for perforated peptic ulcer. [thieme-connect.com]

Female sex, more coexisting clinical events, no evidence of chronic ulcer, and treatment by simple suture were associated with significant poor prognosis on univariate analysis. [jpss.eu]

Original Articles Keywords : Peptic ulcer, perforation, Boey score, prognosis Abhishek Agarwal, Sanchit Jain, LN Meena, Sumita A Jain, Lakshman Agarwal Department of General Surgery, SMS Medical College, Jaipur, India Corresponding Author : Dr. [tropicalgastro.com]

Etiology Risk factors Chronic gastritis caused by H. pylori, a curved, flagellated gram-negative rod Duodenal ulcers : up to 90% are due to H. pylori infection Gastric ulcers : up to 80% are due to H. pylori infection Chronic gastritis of other etiology [amboss.com]

NSAID is one of the contributing etiological factors. Early diagnosis and timely management is advocated to reduce morbidity and mortality. [webmedcentral.com]

Helicobacter pylori is not the predominant etiology for peptic ulcers requiring operation. Am Surg 2011; 77:1054-1060. 2. Bertleff MJ, Lange JF. Perforated peptic ulcer disease: a review of history and treatment. Dig Surg 2010; 27:161-169. 3. [ejs.eg.net]

The etiology of gastrointestinal perforations in the newborn. J Pediatr Surg 1969; 4: 77-80. [ PUBMED ] [ FULLTEXT ] 8. Hernandez DS, Rodrigulz AG. [afrjpaedsurg.org]

Defining the exact etiological factor in any given patient may often be difficult, as more than one risk factor may be present and they tend to interact [ 8 ]. [wjes.biomedcentral.com]

To provide updated epidemiological data on duodenal ulcer perforation, the incidence of the disease in Norfolk, United Kingdom was determined. [ncbi.nlm.nih.gov]

A perforated peptic ulcer is the first differential diagnosis of pneumoperitoneum, but in the socio-epidemiological context of Togo, one should also consider typhoid. [medical-dictionary.thefreedictionary.com]

Epidemiology References: [1] [2] [3] [4] [5] Epidemiological data refers to the US, unless otherwise specified. [amboss.com]

Sonnenberg A, Sengupta A, Bauerfeind P (1988) Epidemiology of peptic ulcer disease. In: MRCP WDWRM, editor. Advances in Peptic Ulcer Pathogenesis [Internet]. Springer Netherlands; 1988: 1-31. [omicsonline.org]

Systematic review of the epidemiology of complicated peptic ulcer disease: incidence, recurrence, risk factors and mortality. Digestion 2011; 84:102-113. 4. Williams N, Bullstrode C, Connell RO. [ejs.eg.net]

This is the first report of massive bowel ischaemia and duodenal perforation with no apparent underlying common pathophysiology leading to this presentation. [ncbi.nlm.nih.gov]

Sleisenger and Fordtran's Gastrointestinal and Liver Disease: Pathophysiology/Diagnosis/Management. 10th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 51. Updated by: Michael M. [medlineplus.gov]

Sleisenger and Fordtran's Gastrointestinal and Liver Disease: Pathophysiology/Diagnosis/Management. 10th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 53. Ford AC, Gurusamy KS, Delaney B, Forman D, Moayyedi P. [mountsinai.org]

References: [12] Pathophysiology Clinical features Gastric ulcer Duodenal ulcer Findings common to both Dyspepsia : postprandial heaviness, early satiety, and gnawing, aching or burning epigastric pain Pain relief with antacids Potential signs of internal [amboss.com]

Despite better understanding of pathophysiology and medical therapy of acid peptic disease, duodenal ulcer perforation remains one of the major cause of Peritonitis. 1,2 The incidence of perforated peptic ulcer in western countries is 7 to 9 per 1,00,000 [webmedcentral.com]

Prompt diagnosis and early therapy is needed to prevent death and prolonged serious illness, and the key to the diagnosis is an awareness of its frequent atypical presentations. [ncbi.nlm.nih.gov]

Doherty Lippincott Williams & Wilkins, 2006 - 826 من الصفحات This volume offers authoritative, evidence-based recommendations for preventing and managing complications in all current general surgery procedures. [books.google.com]

Treatment of the esophagus, stomach or duodenal ulcersaims to relieve pain, heal the ulcer, and prevent complications. [medicinenet.com]

Prevention Avoid aspirin, ibuprofen, naproxen, and other NSAIDs. Try acetaminophen instead. If you must take such medicines, talk to your provider first. [mountsinai.org]