Studies on Omental Implantation with or without Postoperative Complications for Perforated Duodenal Ulcer

Ryouichi Tomita¹⁾²⁾, Shigeru Fujisaki¹⁾, Katsuhisa Tanjoh¹⁾, Eichi Park¹⁾ and Masahiro Fukuzawa¹⁾

¹⁾First Department of Surgery, Nihon University School of Medicine, ²⁾Department of Surgery, The Nippon Dental University

To assess risk factors influencing postoperative complications from perforated duodenal ulcer in patients undergoing omental implantation, we retrospectively studied 20 cases of perforated duodenal ulcer, subdividing patients with perforated into those without postoperative complications (group A; n=10, aged 21.9 and 62.9 years with a mean age of 42.3 years) or with complications (group B; n=10, aged 25.3 and 85.8 years with a mean age of 53.6 years). The postoperative complication rate was 50%. Operative motality was 10%. The most common complications were respiratory diseases. More postoperative complications were seen in group B than group A (p<0.1). Two patients over 60 years old died of uncontrolled disseminated intravascular coagulation (DIC). Durations from disease onset to surgery was less than 10 hours in group A and 72 hours in group B. Total protein concentration was significantly lower in group B than in group A (p<0.01). CRP was significantly higher in group B than in group A (p<0.01). In preoperative hepatic and renal function, electrocardiogram (ECG), and plain chest x-ray findings, complications and mortality were more frequently in patients with hepatic disfunction and abnormal chest x-ray findings. Complications and mortality were more prevalent in patients with low proteinemia and anemia. Bacterial infection involving ascites was greater in group B than in group A. The most common bacteria in ascites were Candida albicans and Klebsiella pneumoniae. Both patients who died had Klebsiella pneumoniae in ascites.

Key words
perforated duodenal ulcer, omental implantation, postoperative complication

Reprint requests
Ryouichi Tomita Department of Surgery, The Nippon Dental University 2-3-16 Fujimi, Chiyoda-ku, Tokyo 102-8158 JAPAN

Accepted
March 28, 2001

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