Perforation of gastroduodenal ulcer continue to be a major complication of ulcerating lesions of the stomach and duodenum and almost invaribly produces a catastrophic event. Since there is a general agreement that perforated peptic ulcers in
patients
who constitute excessive surgical risk should be managed by the simplest possible procedure, an accurate description of the degree of severity of perforated ulcers is essential.
This study attempts to evaluate the prognostic value of the APACHE II scoring system in 118 patients (male-female ratio, 10:1; mean age, 40 years) who underwent emergency operation for perforated duodenal (99 pateints) or gastric (19 patients)
ulcers,
to determine definitive op eration group and to examine its usefulness in stratifying these pateitns according to their surgical risk.
An increasing APACHE II score was associated with an increased mortality rate for patients with perforation of gastroduodenal ulcers. Patients with perforaned gastric ulcer had a higher APACHE II score than those with perforated duodenal ulcer
(7.7±5.6
vs. 4.6±3.9, p=0.0001). The mean APACHE II score in patients who died was 19.8 points compared with 4.5 points in the 108 pateitns with APACHE II scores below II died (0%), whereas mortality rate among the ning patients with scores between 11
and
20
was 33%, and two patients with scores greater than 20 died (100%). The duodenal ulcer patients subjected to definitive operation had lower mortality rate and lower APACHE II scores than those underwent simple closure procedures (1.2% : 12.5%,
3.9±2.8
vs. 8.1±5.7, p=0.0003), but here were no significant differences in patients with perforated gastric ulcer (7.9±4.7 vs. 7.9±3.9, p=0.0675). The mean hospital stay of patients underwent simple closure procedure was longer than that of patients
underwent definitive operations. After definitive operations 79 patients (84%) were estimated to be Visick criteria I or II, but 12 patients (48%) were estimated to be Visick criteria I or II after simple closure procedures.
These results suggest that APACHE II scoring system is a reliable predictor of outcome and useful stratification system in patients with perforated gastroduodenal ulcer. The patients with APACHE II scores below 11 should be managed by the
definitive
operations, the patients with scores between 11 and 20 should be managed by the simplest possible procedures, and the patient with scores above 20 should be managed by simplest possible procedures after conservative managements.
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