الفهرس 
Surgical anatomy of the stomach and duodenumOnly 14 pages are availabe for public view
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Abstract
Outcome of Simple Closure with Omental Patch Repair in Pre-Pyloric and Duodenal Ulcer
Ahmed M. Khalil, M.Sc.*, Khaled A. Elfeky, M.D., Amr M. El Hefny, M.D.,
Ayman H. Abd El Monaem, M.D.
General Surgery Department, Faculty of Medicine, Ain Shams University, Egypt
Corresponding author: Ahmed M. Khalil Tel.(+2): 01140686743, Email:ahmedkhaleel100@gmail.com
ABSTRACT
Background: Peptic ulcer perforation is a serious and life threatening complication which affects 2-10% of peptic ulcer patients on average. The overall mortality of perforated peptic ulcer (PPU) is 10% ranging from 1.3-20%.
Aim of the Study: The aim of the present study was to determine efficiency of omental patch repair after studying the outcome of this method in perforated pre-pyloric gastric ulcer and duodenal ulcer in emergency surgery. We included a total of 40 patients diagnosed with PPU.
Patients and methods: A retrospective cohort study included 40 cases diagnosed with PPU. Patients underwent emergency surgery for simple closure with omental patch repair at general Surgery Department, Damietta General Hospital, Damietta, Egypt. Full history taking, complete clinical examination, Radiological and Laboratory investigations were performed. Good peritoneal toilet and drainage was performed, and the perforation was closed with sutures, and then reinforced by an omental patch.
Results: The mean age of the included patients was 38.78 years. Hypertension was the commonest comorbidity (12.5%). Smokers represented 60% of the included cases, as 24 patients were smokers. History of NSAID intake was reported by 15 patients (37.5%), while previous PUD treatment was reported by 9 patients (22.5%). Abdominal pain was reported by all patients (100%), followed by fever (75%), distension (75%), vomiting (72.5%), constipation (37.5%), and shock (25%). Clinical examination revealed guarding and rigidity in all patients, while rebound tenderness was elicited in 95% of cases. Radiographic examination revealed air under diaphragm in 36 patients (90%). Duodenal perforations were detected in 25 patients (62.5%) while the remaining cases had gastric (prepyloric) perforation. The duration of operation ranged between 52 and 120 minutes (mean = 59 minutes). After operation, twelve patients were admitted to the ICU (30%). Surgical site infection was the most common complication, as it was encountered in 13 patients (32.5%), followed by chest infection (27.5%).
Conclusion: Open omental patch repair of gastroduodenal perforations appears to be safe, efficacious and associated with good post-operative outcomes.
Keywords: Gastroduodenal Perforations; Simple Closure; Open Omental Patch