A Prospective Study on Perforated Peptic Ulcers: Peritoneal Fluid and Its Clinical Relevance to Overall Outcome
Abstract
Objective: To determine whether the spectrum of microorganisms isolated from the peritoneal fluid in a case of perforated peptic ulcer influences the various post-operative complications and the overall outcome of the patient. Perforated Peptic Ulcers (PPUs) carry the risk of severe complications, and extensive peritoneal contamination is common in India, with a potentially different microbial spectrum compared to Western India. Peritoneal fluid culture may be valuable in predicting patient outcomes.
Material and Methods: The study was conducted in the Post Graduate Department of General Surgery, Institute of Medical Sciences & SUM Hospital, Bhubaneswar, Odisha, India, over 3 years and included 525 patients with generalized peritonitis due to PPUs. Peritoneal fluid collected during surgery was analyzed for microorganisms. Postoperative complications and overall outcomes were correlated with the severity of peritonitis and the isolated microorganisms.
Results: In this series, the incidence of PPUs in males outnumbered females 11.5:1, and delayed presentation (>48 hours) occurred in 42.0% of patients. Peritoneal fluid cultures were positive in 59.0% of samples, with Escherichia coli (49.0%) being the most common isolate, followed by Klebsiella pneumoniae (K. pneumoniae), Citrobacter freundii (C. fruendii), Enterococcus faecalis (E. faecalis), and Candida albicans (C. albicans). Culture positivity significantly increased the risk of postoperative complications (odds ratio 6.75 times, p-value<0.05) and the need for critical life support (odds ratio 10.2 times, p-value<0.05).
Conclusion: Peritoneal fluid culture in PPU patients is a crucial investigation, revealing the spectrum of microorganisms and highlighting their impact on disease progression and postoperative outcomes.
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Arveen S, Jagdish S, Kadambari D. Perforated peptic ulcer in South India: an institutional perspective. World J Surg 2009;33:1600-4.
Costa G, Fransvea P, Lepre L, Liotta G, Mazzoni G, Biloslavo A, et al. Perforated peptic ulcer (PPU) treatment: an Italian nationwide propensity score-matched cohort study investigating laparoscopic vs open approach. Surgical Endoscopy 2023;37:5137-49.
Post PN, Kuipers EJ, Meijer GA. Declining incidence of peptic ulcer but not of its complications: a nation-wide study in The Netherlands. Aliment Pharmacol Ther 2011;23:1587-93.
Gowda DB, Kadambari D, Vijayakumar C, Elamurugan TP, Jagdish S. A clinico-microbiological profile in patients with perforated peptic ulcer with special reference to anaerobic organisms: a descriptive study. Int Surg J 2017;4:125-30.
Weledji EP. An overview of gastroduodenal perforation. Front Surg 2020;7:573901.
Almadi MA, Lu Y, Alali AA, Barkun AN. Peptic ulcer disease. Lancet 2024;404:68-81.
Rashid MU, Hussain I, Jehanzeb S, Ullah W, Ali S, Jain AG, et al. Pancreatic necrosis: complications and changing trend of treatment. World J Gastrointest Surg 2019;11:198.
Wolff HG. Stress and disease. Springfield IL: Charles C Thomas; 1953.
Hannan AB, Islam B, Hussain M, Haque MM, Kudrat-E-Khuda MI. Early complications of suture closure of perforated duodenal ulcer: a study of 100 cases. TAJ: J Teach Assoc 2005;18:122-6.
Chalya PL, Mabula JB, Koy M, Mchembe MD, Jaka HM, Kabangila R, et al. Clinical profile and outcome of surgical treatment of perforated peptic ulcers in Northwestern Tanzania: a tertiary hospital experience. World J Emerg Surg 2011;6:1-10.
Shinagawa N, Muramoto M, Sakurai S, Fukui T, Hori K, Taniguchi M, et al. A bacteriological study of perforated duodenal ulcers. Jpn J Surg 1991;21:1-7.
Greco RS, Cahow CE. Alternatives in the management of acute perforated duodenal ulcer. Am J Surg 1974;127:109-14.
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