Perforation remains a serious complication of peptic / malignant ulcer disease and is associated with a high mortality rate. The risk factors for peptic ulcer disease has been well established, but there remains little knowledge about Australian-specific risk factors. Furthermore, there is no clear consensus on the optimal post-operative management strategies to improve outcomes. We report here our surgical experience of perforated gastric and duodenal ulcers in a regional Victorian hospital.
A retrospective analysis of all patients who underwent surgery for perforated gastric or duodenal ulcers between July 2015 and July 2020 at Bendigo Health, Victoria, Australia was undertaken. Statistical analysis was performed with SPSS, version 23.
30 patients required surgery for gastric / duodenal perforations between 2015 and 2020. Median age was 62.5 years (range 19-92 years), with 20 males and 10 females. 26 cases were related to peptic ulcer disease and 4 from a perforated malignancy. The median time to surgery was 299 mins (range 37-586 mins). A laparoscopic approach was used in 23.3%, while a resection was required in 13.3% of cases. 6 patients had positive peritoneal fluid cultures, with the most common organism isolated being Candida species (5 patients). Post-operative contrast studies were performed in 26.7% of patients, with none resulting in a change of management. Overall mortality was 20%. Of the perforated peptic ulcer group, 11.5% (3/26) patients died, while the mortality rate in patients with perforated malignant ulcers was 75% (3/4). Risk factors associated with mortality included age > 60 years (p = 0.019), ASA > 3 (p = 0.029), positive fluid cultures (p = 0.008) and ulcers due to perforated malignancies (p = 0.018).
The morbidity of perforated gastric and duodenal ulcers remains high, with perforated malignant ulcers conferring a particularly significant risk of mortality. The outcomes from our institution are comparable to international results.