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Ochsner J 2020 ;20(2):236-238

Division of Gastroenterology and Hepatology, University of Alabama at Birmingham, Birmingham, AL.

Gastrointestinal stromal tumors (GISTs), although exceedingly rare, are the most common mesenchymal tumors in the gastrointestinal (GI) tract. GISTs are often asymptomatic; approximately 10% are found incidentally on imaging or endoscopy for other indications, although GI bleeding, intestinal obstruction, and perforation can occur. We present a case of upper GI bleeding from a duodenal GIST. Read More

Am J Case Rep 2020 Jul 2;21:e922647. Epub 2020 Jul 2.

Department of General Surgery, Agios Dimitrios General Hospital, Thessaloniki, Greece.

BACKGROUND In the emergency department pain in the right lower quadrant is a frequent finding and is related to a wide variety of diseases, the most common of which is acute appendicitis. An unusual presentation of pain in the right iliac fossa is due to perforation of a duodenal peptic ulcer. The fluid that originates from the perforated ulcer moves through the paracolic sulcus to the right iliac fossa and causes irritation of the peritoneum and even chemical peri-appendicitis, thereby imitating all the usual causes of pain in the right lower quadrant. Read More

J Trauma Acute Care Surg 2020 Jul;89(1):230-237

From the Division of Trauma, Emergency Surgery, and Surgical Critical Care (N.N., J.H., M.K., J.M.L., N.K., G.V., D.K., P.F., N.S., A.M., M.R., H.M.A.K.), Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts; Department of Surgery (N.N.), and Department of Anesthesiology (M.K.), Faculty of Medicine, King Chulalongkorn Memorial Hospital, Chulalongkorn University, Bangkok, Thailand; and Center for Outcomes and Patient Safety in Surgery (H.M.A.K.), Massachusetts General Hospital, Boston, Massachusetts.

Background: Outcome data on the very elderly patients undergoing emergency general surgery (EGS) are sparse. We sought to examine short- and long-term mortality in the 80 plus years population following EGS.

Methods: Using our institutional 2008-2018 EGS Database, all the 80 plus years patients undergoing EGS were identified. Read More

Ann Surg 2020 Jun 16. Epub 2020 Jun 16.

Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, Ohio, USA.

: Multiple tissue samples were obtained during emergent abdominal surgery in four patients with coronavirus disease 2019 (COVID-19) to examine for tissue involvement by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The first patient underwent a laparoscopic cholecystectomy for gallbladder empyema and died from severe respiratory failure. The second patient with Crohn's disease underwent emergent laparotomy for a perforation in the terminal ileum and recovered. Read More

Turk J Surg 2019 Dec 16;35(4):252-258. Epub 2019 Dec 16.

Department of Surgery, Medical College Baroda and Sir Sayajirao General Hospital, Vadodara, India.

Objectives: Perforations in Peptic Ulcer Disease are known to cause considerable morbidity and mortality. The objective of this study was to compare efficacy of known clinical parameters and three existing scoring systems in predicting 30-day mortality and determining mortality risk stratification based on risk factors.

Material And Methods: This was a prospective observational study of 190 patients operated for perforated peptic ulcer over a period of 14 months at a 1500 bed tertiary care university hospital in Western India. Read More

Turk J Surg 2019 Jun 13;35(2):105-110. Epub 2019 Jun 13.

Nnamdi Azikiwe Üniversitesi Eğitim Hastanesi, Cerrahi Bölümü, Nnewi, Nijerya.

Objectives: This study aimed to determine if there is association between gastric perforation and non-steroidal anti-inflammatory drugs (NSAIDs) abuse in patients presenting with perforated peptic ulcer disease (PPUD).

Material And Methods: The data were collected retrospectively from May 2011 to May 2015 and then prospectively until December 2017. Sixty patients diagnosed with PPUD on exploratory laparotomy were evaluated. Read More

BMC Surg 2020 Jun 15;20(1):135. Epub 2020 Jun 15.

CHS, SOM, AAU, Addis Ababa, Ethiopia.

Background: Perforated peptic ulcer disease is a surgical emergency with a high morbidity and mortality. The socio-demographic characteristic and the factors associated with morbidity and mortality seems to differ between the developed and developing world. This is the first a prospective cohort study in Ethiopia designed to analyze pattern and outcome of patients with perforated peptic ulcer disease in four teaching hospitals affiliated with SOM, CHS of Addis Ababa University. Read More

Cir Esp 2020 Jun 9. Epub 2020 Jun 9.

Servicio de Cirugía general y del Aparato Digestivo, Hospital General Universitario de Elche, Elche, Alicante, España.

Enhanced Recovery After Surgery (ERAS) constitutes the application of a series of perioperative measures based on the evidence, in order to achieve a better recovery of the patient and a decrease of the complications and the mortality. These ERAS programs initially proved their advantages in the field of colorectal surgery being progressively adopted by other surgical areas within the general surgery and other surgical specialties. The main excluding factor for the application of such programs has been the urgent clinical presentation, which has caused that despite the large volume of existing literature on ERAS in elective surgery, there are few studies that have investigated the effectiveness of these programs in surgical patients in emergencies. Read More

Emerg Radiol 2020 Jun 6. Epub 2020 Jun 6.

Grupo Fleury, Rua Cincinato Braga, 282, Bela Vista, São Paulo, SP, 01333-010, Brazil.

Fish bones are the most commonly ingested structures and the most common cause of foreign body perforation of the gastrointestinal tract (GIT). Clinical presentation of foreign body GIT perforation is nonspecific, in many cases with clinical signs of acute abdomen, which can mimic appendicitis, diverticulitis, ulcer peptic disease, and other common inflammatory conditions. Besides, patients commonly do not refer that a fish bone was swallowed. Read More

Minerva Chir 2020 May 26. Epub 2020 May 26.

Department of Surgery, University of Modena and Reggio Emilia, AOU Policlinico of Modena, Modena, Italy.

Background: Perforated peptic ulcer is a serious complication of peptic ulcer disease and carries high risk for morbidity and mortality. Although the incidence of peptic ulcer disease has decreased in recent decades, the percentage of patients with perforated peptic ulcer requiring emergency surgery remains constant. The use of laparoscopic management as a first choice for the treatment of the perforation is growing but is not routine in many centers. Read More

J Gastroenterol Hepatol 2020 May 25. Epub 2020 May 25.

Department of Epidemiology and Biostatistics, Institute of Basic Medical Sciences Chinese Academy of Medical Sciences, School of Basic Medicine Peking Union Medical College, Beijing, China.

Background And Aim: Rates and outcomes of hospitalizations for peptic ulcer disease (PUD) are unknown in mainland China. We aimed to describe characteristics and treatments of PUD inpatients in secondary and tertiary care hospitals registered in the national Health Statistics and Information Reporting System in 2015 and to explore factors related to inpatient outcomes.

Methods: We retrieved and validated PUD hospitalization data from 4441 hospitals reporting to Health Statistics and Information Reporting System in 2015. Read More

Korean J Gastroenterol 2020 May;75(5):292-295

Department of Internal Medicine, Busan Paik Hospital, Inje University College of Medicine, Busan, Korea.

Peptic ulcer disease is common and can be diagnosed easily if the patient has an ulcer history or characteristic abdominal symptoms. On the other hand, it may take a long time for the patient to visit the hospital due to severe complications if the patient is old or insensitive to symptoms caused by peptic ulcers. In the present case, a 72-year-old female visited the hospital due to general weakness and inadequate oral intake, which started two weeks ago. Read More

BMC Surg 2020 May 24;20(1):110. Epub 2020 May 24.

Maternal, Fetal and Neonatal Research Center, Tehran University of Medical Sciences, Tehran, Iran.

Background: Peptic ulcer perforation in the early post-cesarean period is rare but may result in maternal mortality.

Case Presentation: Four cases of post-cesarean peptic ulcer perforation are presented. In all four patients, presentations include peritoneal signs such as acute abdominal pain and progressive distention, hemodynamic instability and intraperitoneal free fluid by ultrasound. Read More

Ann Surg 2020 07;272(1):e35-e37

Department of Radiology, The Second Xiangya Hospital, Central South University, No.139 Middle Renmin Road, Changsha, Hunan, P. R. China.

Int J Surg Case Rep 2020 8;70:64-67. Epub 2020 May 8.

Department of General Surgery, North Alentejo Local Unit E.P.E., Portugal.

Background: The prevalence of Peptic Ulcer Disease has decreased as did its elective surgical treatment, however its complications continue to occur. Gastric Outlet Obstruction is the least frequent complication of Peptic Ulcer disease.

Case Summary: In this report, we present a case of massive gastric dilation due to gastric outlet obstruction, that needed emergency surgery due to perforation. Read More

Surg Endosc 2020 May 11. Epub 2020 May 11.

Gastroenterology and Endoscopy Division, Instituto Ecuatoriano de Enfermedades Digestivas, Av. Abel Romero Castillo S/N y Av. Juan Tanca Marengo, Torre Vitalis I, Mezanine 3, 090505, Guayaquil, Ecuador.

Background: Effective hemostasis is essential to prevent rebleeding. We evaluated the efficacy and feasibility of the Over-The-Scope Clip (OTSC) system compared to combined therapy (through-the-scope clips with epinephrine injection) as a first-line endoscopic treatment for high-risk bleeding peptic ulcers.

Methods: We retrospectively analyzed data of 95 patients from a single, tertiary center and underwent either OTSC (n = 46) or combined therapy (n = 49). Read More

Khirurgiia (Mosk) 2020 (4):61-64

Sklifosovsky Research Institute of Emergency Care of the Moscow Healthcare Department, Moscow, Russia.

A 93-year-old patient underwent endoscopic treatment of perforated duodenal ulcer after previous laparoscopic suturing complicated by failure of sutured defect. A self-expanding nitinol stent with partial polyurethane coating was used. Positive effect of the treatment was noted. Read More

Eur Heart J Case Rep 2020 Apr 27;4(2):1-5. Epub 2020 Feb 27.

Department of Radiology and Imaging, Liverpool Heart and Chest Hospital, Thomas Dr, Liverpool L14 3PE, UK.

Background : Primary pericardial mesothelioma is a rare primary cardiac malignancy, with three main histopathological types, sarcomatoid histotype being the rarest. The imaging features were atypical due to concomitant extensive calcification, which resulted in aggravated differential diagnosis.

Case Summary : A 45-year-old man presented to our hospital with non-specific clinical symptoms. Read More

Cureus 2020 Mar 25;12(3):e7406. Epub 2020 Mar 25.

Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, IND.

Background Although the role of Helicobacter pylori (H. pylori) is well known in peptic ulcer disease (PUD) etiology, its role in perforated peptic ulcer (PPU) is not well established. This study aimed to assess the role of H. Read More

Br J Surg 2020 Apr 26. Epub 2020 Apr 26.

Division of General Surgery, Royal Derby Hospital, Derby Hospitals NHS Trust, Derby, UK.

Background: To achieve completion of training in general surgery, trainees are required to demonstrate competency in common procedures performed at emergency laparotomy. The aim of this study was to describe the patterns of trainee-led emergency laparotomy operating and the association between postoperative outcomes.

Methods: Data on all patients who had an emergency laparotomy between December 2013 and November 2017 were extracted from the National Emergency Laparotomy Audit database. Read More

BMC Surg 2020 Apr 19;20(1):79. Epub 2020 Apr 19.

Department of Digestive Surgery, Niigata City General Hospital, 463-7 Shumoku, Chou-ku, Niigata City, 950-1197, Japan.

Background: Perforation of a marginal peptic ulcer after pancreaticoduodenectomy (PD) can lead to severe conditions, although its clinical features have not been well reported. In this article, we present three cases of marginal peptic ulcer perforation after PD that we experienced in our institute and attempt to clarify its appropriate treatment and prevention.

Case Presentation: Marginal ulcer perforation confirmed with computed tomography and/or surgical exploration occurred in 3 (1. Read More

Khirurgiia (Mosk) 2020 (3):13-21

Pirogov Russian National Research Medical University of the Ministry of Health of Russia, Moscow, Russia.

Aim: To compare the results of open and laparoscopic interventions for PGDU complicated by advanced peritonitis.

Material And Methods: A retrospective analysis enrolled 172 patients with PGDU who underwent surgery for the period 2014-2016. The research was performed at the bases of the Department of Faculty-Based Surgery No. Read More

J Trauma Acute Care Surg 2020 Mar 30. Epub 2020 Mar 30.

Division of Trauma, Emergency Surgery, and Surgical Critical Care, Massachusetts General Hospital, Boston, MA, Harvard Medical School, Boston, MA.

Background: Outcome data on the very elderly patients undergoing emergency general surgery (EGS) are sparse. We sought to examine short and long-term mortality in the 80+ population following EGS.

Methods: Using our institutional 2008-2018 EGS Database, all the 80+ patients undergoing EGS were identified. Read More

Ann Glob Health 2020 02 25;86(1):19. Epub 2020 Feb 25.

Department of Surgery, The Pennsylvania State University, College of Medicine, Hershey, PA, US.

Background: Perioperative mortality rate (POMR) has been identified as an important measure of access to safe surgical and anesthesia care in global surgery. There has been limited study on this measure in rural Ghana. In order to identify areas for future quality improvement efforts, we aimed to assess the epidemiology of exploratory laparotomy and to investigate POMR as a benchmark quality measure. Read More

Curr Probl Surg 2020 02 7;57(2):100728. Epub 2020 Jan 7.

Duke University Medical Center, Durham, NC. Electronic address:

Cureus 2020 Jan 22;12(1):e6741. Epub 2020 Jan 22.

Internal Medicine, Dow University of Health Sciences, Karachi, PAK.

Introduction Perforation, obstruction, and bleeding remain the most frequently encountered complications of peptic ulcer disease (PUD). Bleeding may be in the form of hematemesis or melena. The treatment of choice in patients with a bleeding peptic ulcer is endoscopic ligation to maintain the hemostatic balance followed by the administration of proton pump inhibitors (PPIs). Read More

BMJ Open Gastroenterol 2020 17;7(1):e000350. Epub 2020 Feb 17.

Department of Surgery, Penn State Hershey College of Medicine and Milton S. Hershey Medical Center, Hershey, Pennsylvania, USA.

Introduction: In 2013, peptic ulcer disease (PUD) caused over 300 000 deaths globally. Low-income and middle-income countries are disproportionately affected. However, there is limited information regarding risk factors of perioperative mortality rates in these countries. Read More

Clin Case Rep 2020 Feb 20;8(2):239-242. Epub 2020 Jan 20.

Department of Gastroenterology Wright State University Boonshoft School of Medicine Dayton OH USA.

Gastrointestinal ulcers and perforations can occur as a complication of nonsteroidal anti-inflammatory drugs (NSAID). Emerging endoscopic technologies can be utilized to successfully intervene perforations that fail surgical intervention. We report a case of perforated duodenal ulcer that failed surgical intervention and, however, was successfully closed with over-the-scope clip (OTSC) closure with concomitant placement of fully covered stent. Read More

Euroasian J Hepatogastroenterol 2019 Jul-Dec;9(2):91-95

Department of General Surgery, Government Medical College and Hospital, Nagpur, Maharashtra, India.

Background: Perforation peritonitis is one of the commonest encountered emergencies in the surgery casualty. This study was conducted with the aim of identifying risk factors in peptic ulcer disease (PUD) in young patients.

Materials And Methods: Seventy patients were evaluated in this study and were followed up with clinical examination and endoscopy at 8 weeks and 6 months. Read More

Rev Gastroenterol Mex 2020 Apr - Jun;85(2):190-206. Epub 2020 Feb 21.

Departamento de Gastroenterología, Hospital Juárez, Ciudad de México, México.

More than 30 million persons worldwide take nonsteroidal anti-inflammatory drugs (NSAIDs) on a daily basis, and annual consumption is increasing. In addition to their analgesic and anti-inflammatory properties, NSAIDs also produce well-known gastrointestinal adverse events. There is no consensus in Mexico on the diagnosis, treatment, and prevention of NSAID-induced gastropathy and enteropathy, and so the Asociación Mexicana de Gastroenterología brought together a group of experts to establish useful recommendations for the medical community. Read More

JGH Open 2020 Feb 27;4(1):90-93. Epub 2019 Feb 27.

Division of Surgical Gastroenterology, Department of General Surgery Postgraduate Institute of Medical Education and Research Chandigarh India.

Aspergillosis is an opportunistic infection commonly seen in immunocompromised patients. Patients with hematological malignancies, postorgan transplantation, or those with comorbid conditions are susceptible to the development of invasive aspergillosis. Lungs are the main portal of entry and are thus most commonly involved. Read More

G Chir 2020 Jan-Feb;41(1):40-45

Aim: The purpose of this study is to analyze the outcome of elderly patients with perforated peptic ulcer comparing laparoscopic treatment versus open approach.

Methods: In our General and Emergency Surgery Unit in the last 3 years, 20 elderly patients with perforated peptic ulcer were performed. We considered elderly all patients over the age of 65 years (10 females and 10 males; the mean age was 75 years). Read More

Int J Surg 2020 03 24;75:11-12. Epub 2020 Jan 24.

Department of Surgical Gastroenterology, Aarhus University Hospital, Denmark.

World J Emerg Surg 2020 7;15. Epub 2020 Jan 7.

1Emergency Surgery Department, Parma University Hospital, Parma, Italy.

Background: Peptic ulcer disease is common with a lifetime prevalence in the general population of 5-10% and an incidence of 0.1-0.3% per year. Read More

Ann Med Surg (Lond) 2020 Jan 17;49:24-27. Epub 2019 Nov 17.

Department of Surgery, Hospital Felício Rocho, Av. Do Contorno, 9530 - Barro Preto, Belo Horizonte, MG, 30110-934, Brazil.

Introduction: Among the many techniques available for bariatric surgery, the Mini Gastric Bypass is a safe, technically simple and effective option. However, it may present with postoperative complications, being the perforated gastric ulcer one of the most relevant ones.

Presentation Of Case: A female patient of 41 years of age, with past medical history of a laparoscopic MGB performed 2 year before, presented with 12 hours of sharp and abruptly initiated abdominal pain, with diffuse presentation with suspected perforated acute abdomen after initial medical assessment and examination. Read More

Jpn J Radiol 2020 Feb 17;38(2):101-111. Epub 2019 Dec 17.

Department of Radiology, Biomedical Research Institute, Pusan National University Hospital, and Pusan National University School of Medicine, 179, Gudeok-ro, Seo-gu, Busan, 49241, Korea.

Gastrointestinal tract (GI) perforations can occur due to various causes such as trauma, iatrogenic factor, infectious condition, peptic ulcer, inflammatory disease, or a neoplasm. Because GI perforations represent an emergency and life-threatening condition, prompt diagnosis and surgical treatment are required in most cases. However, according to the underlying causes of GI perforations, additional treatment strategies may be needed. Read More

Int J Surg 2020 01 25;73:10-11. Epub 2019 Nov 25.

Tehran University of Medical Science, Tehran, Iran. Electronic address:

Int J Surg 2019 12 22;72:242-243. Epub 2019 Nov 22.

Department of Surgery, General Surgery Operative Unit, "San Giovanni di Dio" Hospital, Crotone, Italy. Electronic address:

J Gastrointest Surg 2019 Nov 19. Epub 2019 Nov 19.

Graduate Institute of Clinical Medical Science, China Medical University, Taichung, Taiwan.

Objectives: The management of perforated peptic ulcer (PPU) has shifted from vagotomy/drainage to simple closure, followed by postoperative proton pump inhibitors (PPIs) and Helicobacter pylori (HP) eradication. Few studies have focused on the long-term impacts of this trend shift. We hypothesize that simple closure with PPIs is sufficient and does not carry an elevated rate of repeated surgery in non-HP-infected PPU patients. Read More

Trop Doct 2020 Jan 19;50(1):15-19. Epub 2019 Nov 19.

Department of Medical Microbiology and Immunology, Faculty of Medicine, Gulu University, Gulu, Uganda.

We studied our 30-day postoperative outcomes in patients with non-traumatic gastroduodenal perforation (NTGDP) in Mbarara Regional Referral Hospital, southwestern Uganda. We conducted a one-year prospective study of patients who underwent exploratory laparotomy for suspected NTGDP between June 2016 and July 2017. Twenty-nine patients had NTGDP, the male-to-female ratio was 3:1 and median age was 60 years (range = 13-80 years). Read More

Kathmandu Univ Med J (KUMJ) 2018 Oct.-Dec.;16(64):296-300

Department of Conservative Dentistry and Endodontics, Gandaki Medical College, Pokhara, Nepal.

Background Peritonitis due to hollow viscus perforation is one of common surgical emergency. Its accurate diagnosis and management is a challenge to every surgeon. This led to the development of disease severity grading systems that would aid in management and appropriately predict possible outcome. Read More

Ulus Travma Acil Cerrahi Derg 2019 Oct;25(6):585-588

Department of General Surgery, İnönü University Faculty of Medicine, Malatya-Turkey.

Background: Perforation is a rare complication of peptic ulcer. Although the most widely accepted treatment for peptic ulcer perforation is surgery, non-operative treatment can be an option in selected patients. In this study, we aimed to present our non-surgical treatment experience in peptic ulcer perforation. Read More

Ulus Travma Acil Cerrahi Derg 2019 Oct;25(6):580-584

Department of General Surgery, İnönü University Faculty of Medicine, Malatya-Turkey.

Background: Open or laparoscopic Graham's omentopexy is frequently used in the treatment of peptic ulcer perforation (PUP). The technical difficulty of applying the omental plug, especially in patients with previous omentum resection, has led to the use of falciform ligament for the PUP, and some studies have reported that PUP may even be a more advantageous technique than omentopexy. Here, in this study, we aimed to compare the retrospective results of patients who underwent falciformopexy or omentopexy for PUP. Read More

Asian J Surg 2020 Jan 31;43(1):311-314. Epub 2019 Oct 31.

Division of General Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, ROC. Electronic address:

Objective: We evaluated the outcomes of laparoscopic repair of perforated peptic ulcers using simple closure only.

Methods: This retrospective study included 79 patients who underwent laparoscopic repair of perforated peptic ulcers from January 2011 to February 2016. They were divided into two groups: repair with an omental patch and repair with simple closure only. Read More

Chirurgia (Bucur) 2019 Sept-Oct;114(5):639-649

Pancreatic neuroendocrine tumors (PNETs) are rare and characterized by widely variable clinical presentation and often challenging surgical management. Retrospective study conducted during the last 15 years at the First Surgical Clinic of the Iasi St Spiridon University Hospital, and which included all the patients diagnosed with pancreatic endocrine tumors by immunohistochemistry. There were 26 cases diagnosed with PNET. Read More

World J Surg 2020 Mar;44(3):869-875

National Emergency Laparotomy Audit Project Team, Royal College of Anaesthetists, London, UK.

Background: Delay to theatre for patients with intra-abdominal sepsis is cited as a particular risk factor for death. Our aim was to evaluate the potential relationship between hourly delay from admission to surgery and post-operative mortality in patients with perforated peptic ulcer (PPU).

Methods: All patients entered in the National Emergency Laparotomy Audit who had an emergency laparotomy for PPU within 24 h of admission from December 2013 to November 2017 were included. Read More

Int J Surg 2019 Dec 19;72:47-54. Epub 2019 Oct 19.

Department of Surgical Gastroenterology, Aarhus University Hospital, Denmark. Electronic address:

Background: Laparoscopic surgery has become increasingly popular in treating perforated peptic ulcer (PPU). However, currently it is not recognized as a prognostic factor for mortality within this group of patients. The aim of this study was to investigate whether laparoscopic surgery was an independent mortality risk factor in patients treated surgically for perforated peptic ulcer. Read More