Perforated peptic ulcer – pre-operative risks, postoperative morbidity and mortality, prophylaxis in intensive care and guidelines

Česká verze

Authors: Satinský Igor ^1,2
Authors place of work: Mezioborová jednotka intenzivní péče, Nemocnice Havířov ¹; Slezská univerzita, Fakulta veřejných politik, Opava ²
Published in the journal: Anest. intenziv. Med., 23, 2012, č. 5, s. 259-263
Category: Kurz intenzivní medicíny*

*Novinky v oboru, Praha, prosinec 2011

Summary

This review analyses studies reporting preoperative risk factors for postoperative morbidity and mortality in patients with perforated peptic ulcer in the literature in the last 10 years. There exists a number of factors clearly associated with increased morbidity and mortality in this illness: advanced age, co-existing diseases, malnutrition, shock on admission and delayed surgery. Because some of the factors are predetermined, reduction in mortality is difficult to achieve. On the other hand detection of risk factors allows to stratify patients and to reduce the incidence of postoperative complications. Some scoring systems exist to determine the risk level (Boey’s score, Mannheim Peritonitis Index).

The first choice of treatment is early surgical suture of the perforation and plugging of the perforation with pedicled omentoplasty, accompanied by irrigation and drainage of the peritoneal cavity. The use of drains, routine postoperative nasogastric decompression and antibiotic prophylaxis should be reduced and applied in selected cases only. There is no strong evidence favouring proton pump inhibitors against H2 receptor antagonists.

Stress ulcer prophylaxis in intensive care patients should be given to at-risk patients without enteral nutrition only. Patients with enteral nutrition do not benefit from stress ulcer prophylaxis and indeed such therapy may increase the risk of nosocomial pneumonia and colitis.

Keywords:
perforated peptic ulcer – preoperative risks – postoperative mortality – prophylaxis – guidelines

Zdroje

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