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Gastroduodenal Perforations

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Abdominal Sepsis

Part of the book series: Hot Topics in Acute Care Surgery and Trauma ((HTACST))

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Abstract

While the incidence of peptic ulcer disease has declined over the past decades, the rate of perforations has remained fairly stable during the same time. A perforated gastroduodenal ulcer is still associated with a high mortality, particularly in the elderly group of patients. Clinical signs may be clear (sudden onset of acute upper abdominal pain, rigid abdomen on palpation), but clinical signs and lab values are subtler with increasing age, often leading to a missed or delayed diagnosis. Computed tomography is the standard imaging test of choice, due to its superior sensitivity and ability to detect differential diagnoses. Management strategies concern the pre-, peri-, and postoperative course, and a care bundle to ensure compliance to all aspects is instrumental. Early resuscitation should start prior to surgery and includes empiric initiation of broad-spectrum antibiotics. Source control is imperative, either by open or laparoscopic approach. Postoperative management should follow the patient’s status; young and fit patients may be candidates for an early discharge, while elderly are more likely to have an unfavorable outcome and require more resources.

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Author information

Authors and Affiliations

  1. Department of Gastrointestinal Surgery, Stavanger University Hospital, POB 8100, 4068, Stavanger, Norway

    Kjetil Søreide M.D., Ph.D.

  2. Department of Clinical Medicine, University of Bergen, Bergen, Norway

    Kjetil Søreide M.D., Ph.D.

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  1. Kjetil Søreide M.D., Ph.D.
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Correspondence to Kjetil Søreide M.D., Ph.D. .

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Editors and Affiliations

  1. Department of Surgery, Macerata Hospital, Macerata, Italy

    Massimo Sartelli

  2. University of Udine, Infectious Diseases Division , Udine, Italy

    Matteo Bassetti

  3. St James's University Hospital, Trinity Centre for Health Sciences , Dublin, Ireland

    Ignacio Martin-Loeches

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Søreide, K. (2018). Gastroduodenal Perforations. In: Sartelli, M., Bassetti, M., Martin-Loeches, I. (eds) Abdominal Sepsis. Hot Topics in Acute Care Surgery and Trauma. Springer, Cham. https://doi.org/10.1007/978-3-319-59704-1_9

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  • DOI: https://doi.org/10.1007/978-3-319-59704-1_9

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  • Publisher Name: Springer, Cham

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  • Online ISBN: 978-3-319-59704-1

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