A Case Series Depicting Pathological Presentation of Perforated Giant Gastric Ulcer and Emergency Treatment Modality

Dr. DHANESH KUMAR

Volume : VIII, Issue : VIII, August - 2019

A Case Series Depicting Pathological Presentation of Perforated Giant Gastric Ulcer and Emergency Treatment Modality

Dr. Dhanesh Kumar

Abstract :

Aim: To study and assess pathological presentation of Giant gastric ulcer and clinical outcomes of various modes of treatment for perforated giant gastric ulcer in an emergency setting. Methods: From Feb 2014 to Feb 2019, 20 cases of perforated giant gastric ulcer (> 2 cm) were operated on in an emergency setting. All the patients presented with features of peritonitis and were resuscitated aggressively before taking for surgery. In the first 4 cases, primary closure was done after taking a biopsy and among these, the 3rd case also underwent partial distal gastrectomy and gastrojejunostomy and the 4th case underwent a radical subtotal gastrectomy with D2 lymphadenectomy and gastrojejunostomy for malignancy. All the remaining 16 cases underwent partial distal gastrectomy and gastrojejunostomy. Results: Among the first 4 cases, 2 had an uneventful recovery and were discharged on the 6th postoperative day. The 3rd and 4th patients developed gastric fistula, leading to prolonged hospitalization. For the 3rd patient, conservative management was tried for 1 wk, followed by partial distal gastrectomy and gastrojejunostomy, and he was discharged on the 20th day after admission, while the 4th patient underwent a radical subtotal gastrectomy with D2 lymphadenectomy and gastrojejunostomy. Postoperatively, he developed adult respiratory distress syndrome, multiorgan dysfunction syndrome and expired on the 3rd postoperative day of the second surgery. All the remaining 16 patients underwent partial distal gastrectomy and gastrojejunostomy and recovered well. Among these, 4 of them were malignant and the remaining were benign ulcers. All had an uneventful recovery. The percentage of malignancy in our series was 30% (6 out of 20 cases). In our study, 86% had an uneventful recovery, complications were seen in about 10%, and mortality was about 5%. CONCLUSION: In giant gastric ulcer, the chances of malignancy and leak after primary closure are high. So, we feel that partial distal gastrectomy and gastrojejunostomy is better.