What is the preferred surgery for treatment of perforated gastric ulcer? Excision of the ulcer with or without vagotomy and drainage. The major distinction between surgical management of perforated duodenal and perforated gastric ulcers is that in all cases of perforated gastric ulcers, carcinoma must be excluded. Thus all perforated gastric ulcers must undergo biopsy …
What are the three major goals of Surgery for perforated PUD? Repair of the perforation is usually performed by suturing the perforation closed and buttressing the repair with omental fat as a Graham patch The abdominal cavity is copiously irrigated. Definitive ulcer operation is performed. A patient who has had a perforation for less than …
What are the contraindications to medical management of perforated PUD? Concurrent use of corticosteroids, which makes healing unlikely Continued leak, as demonstrated by a contrast radiograph Perforation in a patient taking an H 2 -receptor antagonist or a PPI. A definitive ulcer operation is necessary to allow ulcer healing and to reduce the risk of recurrence
Why do almost all perforated gastric ulcers require a surgery? Perforated gastric ulcers constitute 40% of overall perforated peptic ulcers, and duodenal ulcers the remaining 60%. Unlike perforated duodenal ulcers, which may be treated nonoperatively if the ulcer has sealed itself as demonstrated on Gastrografin swallow, perforated gastric ulcers usually fail to heal spontaneously. They …
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presentation of a patient with a perforated peptic ulcer Patients usually describe a prodrome of gnawing localized pain in the epigastric region prior to perforation. With acute perforation, the epigastric pain becomes diffuse as a result of release of acidic fluid in the peritoneal cavity and the resulting release of vasoactive mediators, and is often …
Most appropriate elective surgical procedure for duodenal ulcers and each type of gastric ulcer The choice of operation for gastric ulcers depends on several factors: ulcer location, acid secretory status, and presence of a coexistent duodenal ulcer. In general, gastric ulcers should be included with the resection while duodenal ulcers heal after acid suppression. Type …
Intractability in terms of the medical treatment of PUD Intractability is defined as mucosal healing refractory to maximal medical therapy. The following three criteria define a refractory ulcer and are generally indications for operative intervention: Ulcer persistence after 2 months of PPI or 3 months of H 2 -antagonist treatment Ulcer recurrence within 1 year, despite maintenance medical therapy …
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