Small Bowel: The Problematic Duodenal Perforation
While the overall incidence of acid-peptic ulcer disease continues to decrease, perforated duodenal ulcers continue to occur. This is particularly true in elderly patients where the incidence of infection with Helicobacter pylori is the highest, and there
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Small Bowel: The Problematic Duodenal Perforation David V. Feliciano
Introduction Acid-peptic Helicobacter ulcer disease is rarely discussed at academic conferences in the modern era. This is not surprising in light of the continuing decrease in operations performed for gastric and duodenal ulcers and their complications over the past 5 decades. This trend continues in the modern era with further decreases in admissions (40–50 %), hospital deaths, hospitalizations for perforations, and deaths per perforation [1]. Some epidemiologic series, however, have noted that the incidence of “peptic ulcer disease complicated by either bleeding or perforation has remained constant or even decreased” [2]. Lee and Sarosi note that this is related to the increased incidence of NSAID-related ulcer disease in elderly patients in the United States as the incidence of Helicobacter infections has decreased in younger patients [2].
Operative Management The operative management of perforated ulcer disease has changed over the past 25 years, as well. Prior to the rediscovery of Helicobacter pylori by JR Warren and BJ Marshall in the early 1980s, perforated gastric and duodenal ulcers were considered to be life-threatening diseases to be treated aggressively in patients with a chronic (>3 months) history of ulcer disease [3–5]. Therefore, truncal vagotomy and antrectomy or hemigastrectomy were often performed in hemodynamically D.V. Feliciano (&) IU Division of General Surgery, Indiana University Hospital, Indiana University Medical Center, 545 Barnhill Drive, EH 509, Indianapolis, IN 46202, USA e-mail: [email protected] © Springer International Publishing Switzerland 2017 J.J. Diaz and D.T. Efron (eds.), Complications in Acute Care Surgery, DOI 10.1007/978-3-319-42376-0_11
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stable patients [4, 5]. In contrast, patients with an acute (
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