Septic complications of perforated peptic ulcer: clinical experience in Loei hospital.

Abstract

Objectives: A retrospective descriptive study aimed to identify pathogens from hemoculture and ascites fluid culture to prove that peptic ulcer perforation with septic complications are systemic infection or systemic inflammatory response syndrome.

Methods: All 107 patients undergoing emergency surgery of perforated peptic ulcer (PPU) between 1st May 2007 – 30th June 2009 in Loei hospital were recruited. All patients were undergone simple suture with or without omental graft. Demographic characteristics, clinical presentations, investigations, pathogens, hemoculture, ascites fluid culture and surgical outcomes include complication were analyzed.

Results: The study included 107 patients with age from 25-86 years old average 58.76 (S.D.14.1) mostly were male 89.7%, type V was the most common type of ulcer 75.7%. Overall morbidity rate was 14.9% and the mortality rate was 4.7%. Hemoculture was positive in 11.7%. Most common pathogen from hemoculture was Staphylococcus coagulase negative 7.8%. Ascites fluid culture was positive in 23.4%. with pathogens were Gram negative bacteria, Yeast and Gram positive bacteria 15.9%, 12.1% and 9.3% respectively. Morbidity and mortality depend on ascites fluid culture especially fungal infection.

Conclusions: Incidence of positive hemoculture in septic complication of perforated peptic ulcer is quite low (11.7%). The most common pathogens were Gram negative bacteria, Yeast and Gram positive bacteria respectively. If yeast was found from ascites fluid culture, patient may need intensive care due to high morbidities and mortality. Antifungal therapy may need in some patients, however more information should be study.