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Abdominal SepsisGastroduodenal Perforations

Abdominal Sepsis: Gastroduodenal Perforations [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.] http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png

Abdominal SepsisGastroduodenal Perforations

Part of the Hot Topics in Acute Care Surgery and Trauma Book Series
Editors: Sartelli, Massimo; Bassetti, Matteo; Martin-Loeches, Ignacio
Søreide, Kjetil
Abdominal Sepsis — Jun 23, 2017
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8 pages

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Publisher
Springer International Publishing
Copyright
© Springer International Publishing AG, part of Springer Nature 2018
ISBN
978-3-319-59703-4
Pages
95 –103
DOI
10.1007/978-3-319-59704-1_9
Publisher site
See Chapter on Publisher Site

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.]

Published: Jun 23, 2017

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