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KMID : 0365719960120010085
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Journal of Pusan Surgical Society
1996 Volume.12 No. 1 p.85 ~ p.93
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A Clinical Study of Peptic Ulcer Perforation in the Elderly over 60 Years of Age
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Abstract
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The article is a clinical study of 51 cases of peptic ulcer perforation, surgically treated, over 60 years of age at the Department of Surgery in the Pusan Medical Center from January, 1986 to December, 1994.
@ES The results were as follows :
@EN 1) In sex distribution 37 cases were male and 14 cases were female with the ratio 2.6 : 1.
2) In disease distribution, 17 cases were gastric ulcer perforation and 34 cases were duodenal ulcer perforation. The most common site of perforation was duodenal bulb which involved 34 cases.
3) In the seasonal variation, fall was the predominant season which involved 18 cases and 9 cases among them occurred in Semptember.
4) The duration of the prodromal symptom prior to perforation was most common for over 3 years with 22 cases(43.1%), but 8 cases (15.7%) had no definitive prodromal ulcer symptom.
5) The associated disease was observed in 31 cases (60.8%). The diseases were hepatitis, pulmonary tuberculosis, chronic obstructive pulmonary disease, diabetes mellitus, ischemic heart disease, cerebrovascular disease and schizophrenia in
order.
6) Subdiaphragmatic free air was observed in 46 cases on chest P-A and erect plain abdomen film.
7) In method of surgical procedure, simple closure was performed in 14 cases, truncal vagotomy with pyloroplasty in 25 cases, truncal vagotomy with antrectomy in 3 cases and subtotal gastrectomy in 9 cases.
8) Early postoperative complications : Wound infection was the most common with 12 cases, pulmonary complication with 10 cases, small bowel ileus with 5 cases, hemorrhage with 1 case and stump leakage with 1 case in order.
9) In case of the interval over 24 hours between the symptom onset and the operation, and in the presence of the associated disease and lower serum albumin level (below 3.5 mg%), the mortality rate was over twice than in other cases.
10) In aspect of the postoperative recurrence of peptic ulcer disease, 8 cases (57.1%) were observed in simple closure but there was no evidence of recurrence in gastric resection procedures. The deaths were observed in 3 cases of subtotal
gastrectomy,
2 cases of simple closure, 2 cases of truncal vagotomy with pyloroplasty and 1 case of truncal vagotomy with antrectomy.
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