Nzarubara Gabriel R
Makerere University, Faculty of Medicine, Department of Anatomy, P.O. Box 7072, Kampala, Uganda.
Afr Health Sci. 2005 Mar;5(1):73-8.
Our understanding of the cause and treatment of peptic ulcer disease has changed dramatically over the last couple of decades. It was quite common some years ago to treat chronic ulcers surgically. These days, the operative treatment is restricted to the small proportion of ulcer patients who have complications such as perforation. The author reports seven cases of perforated duodenal ulcers seen in a surgical clinic between 1995 and 2001. Recommendations on the criteria for selecting the appropriate surgical intervention for patients with perforated duodenal ulcer are given.
To decide on the appropriate surgical interventions for patients with perforated duodenal ulcer.
These are case series of 7 patients who presented with perforated duodenal ulcers without a history of peptic ulcer disease.
Seven patients presented with perforated duodenal ulcer 72 hours after perforation in a specialist surgical clinic in Kampala were analyzed. Appropriate management based on these patients is suggested.
These patients were initially treated in upcountry clinics for acute gastritis from either alcohol consumption or suspected food poisoning. There was no duodenal ulcer history. As a result, they came to specialist surgical clinic more than 72 hours after perforation. Diagnosis of perforated duodenal ulcer was made and they were operated using the appropriate surgical intervention.
Diagnosis of hangovers and acute gastritis from alcoholic consumption or suspected food poisoning should be treated with suspicion because the symptoms and signs may mimic perforated peptic ulcer in "silent" chronic ulcers. The final decision on the appropriate surgical intervention for patients with perforated duodenal ulcer stratifies them into two groups: The previously fit patients who have relatively mild physiological compromise imposed on previously healthy organ system by the perforation can withstand the operative stress of definitive procedure. The Second category includes patients who are critically ill, who poorly tolerate any operation and hence poor surgical risks. These require urgent, adequate resuscitation and simple suture with omental patch.
在过去几十年里，我们对消化性溃疡病病因及治疗的理解发生了巨大变化。几年前，通过手术治疗慢性溃疡相当普遍。如今，手术治疗仅限于一小部分出现穿孔等并发症的溃疡患者。作者报告了1995年至2001年间在一家外科诊所见到的7例十二指肠溃疡穿孔病例。给出了关于为十二指肠溃疡穿孔患者选择合适手术干预标准的建议。
为十二指肠溃疡穿孔患者确定合适的手术干预措施。
这是一组7例无消化性溃疡病史的十二指肠溃疡穿孔患者的病例系列。
对在坎帕拉一家专科外科诊所穿孔72小时后出现十二指肠溃疡穿孔的7例患者进行了分析。建议根据这些患者情况进行适当管理。
这些患者最初在内陆诊所因饮酒或疑似食物中毒被当作急性胃炎治疗。他们没有十二指肠溃疡病史。结果，穿孔72小时后才来到专科外科诊所。确诊为十二指肠溃疡穿孔后，对他们进行了适当的手术干预。
对于因饮酒或疑似食物中毒导致的宿醉和急性胃炎的诊断应持怀疑态度，因为其症状和体征可能与“无症状”慢性溃疡中的消化性溃疡穿孔相似。为十二指肠溃疡穿孔患者选择合适手术干预的最终决定将他们分为两组：第一组是身体状况较好的患者，穿孔对先前健康的器官系统造成的生理损害相对较轻，能够承受确定性手术的手术应激。第二类包括病情危急、任何手术耐受性差因而手术风险高的患者。这些患者需要紧急、充分的复苏，并进行简单的带网膜补片缝合。
