What Is Duodenal Perforation?
Perforation occurs in 2-10% of patients with PUD and accounts for more than 70% of deaths associated with PUD. Often perforation is the first clinical presentation of PUD [18]. The incidence of duodenal perforation is 7-10 cases/ 100.000 adults per year. [9, 15, 16, 19-22]. The perforation site usually involves the anterior wall of the duodenum (60%), although it might occur antral (20%) and lesser-curvature gastric ulcers (20%) [19]. Duodenal ulcer is the predominant lesion of the western population, whereas gastric ulcers are more frequent in oriental countries, particularly in Japan. Gastric ulcers have a higher associated mortality and a greater morbidity resulting from haemorrhage, perforation and obstruction [17]. PPU used to be a disorder
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Often these symptoms were contributed to poisoning and people have been sent to prison for this [1]. King Charles I’s daughter, Henriette-Anne, died suddenly in 1670 (at age 26) after a day of abdominal pain and tenderness. Since poisoning was suspected autopsy was performed and revealing peritonitis and a small hole in the anterior wall of the stomach. However, the doctors had never heard of a perforated peptic ulcer (PPU) and attributed the hole in the stomach to the knife of the dissector [1, 2]. Necropsies were first allowed since 1500 and became more routine between 1600 and 1800 [2, 3]. As a consequence more often perforation of the stomach was observed. Johan Mikulicz- Radecki (1850-1905), often referred to as the first surgeon who closed a perforated peptic ulcer (PPU) by simple closure said: “ Every doctor, faced with a perforated duodenal ulcer of the stomach or intestine, must consider opening the abdomen, sewing up the hole, and averting a possible in"ammation by careful cleansing of the abdominal cavity” [4]. Surprising enough treatment since has not changed much, still consisting of primary closure of the perforation by single stitch suture and a convenient tag of adjacent omentum on top of this [5-8]. Although this therapy sounds very simple still PPU remains a dangerous surgical condition, associated with high morbidity and mortality, not to be underestimated
Often these symptoms were contributed to poisoning and people have been sent to prison for this [1]. King Charles I’s daughter, Henriette-Anne, died suddenly in 1670 (at age 26) after a day of abdominal pain and tenderness. Since poisoning was suspected autopsy was performed and revealing peritonitis and a small hole in the anterior wall of the stomach. However, the doctors had never heard of a perforated peptic ulcer (PPU) and attributed the hole in the stomach to the knife of the dissector [1, 2]. Necropsies were first allowed since 1500 and became more routine between 1600 and 1800 [2, 3]. As a consequence more often perforation of the stomach was observed. Johan Mikulicz- Radecki (1850-1905), often referred to as the first surgeon who closed a perforated peptic ulcer (PPU) by simple closure said: “ Every doctor, faced with a perforated duodenal ulcer of the stomach or intestine, must consider opening the abdomen, sewing up the hole, and averting a possible in"ammation by careful cleansing of the abdominal cavity” [4]. Surprising enough treatment since has not changed much, still consisting of primary closure of the perforation by single stitch suture and a convenient tag of adjacent omentum on top of this [5-8]. Although this therapy sounds very simple still PPU remains a dangerous surgical condition, associated with high morbidity and mortality, not to be underestimated