Surgical management of combined perforated and bleeding duodenal ulcer

Background: Peptic ulcer is one of the most frequent diseases of the alimentary tract, while mortality from perforated peptic ulcer still remains high. We conducted this retrospective study to determine the adverse operative risk factors for perforated hemorrhagic peptic ulcers in Shiraz, southern Iran. Methods: 896 patients with peptic ulcer were enrolled. A questionnaire was used to collect the data on age, gender, site of ulcer, presentation, endoscopic findings, type of peptic ulcer complications, method of treatment, surgical procedure, and results of the treatment. Results: Complicated duodenal ulcer was 15% in period I, and 11.5% in period II (P>0.05). The mean +/- SD of the age of the patients was 42.7 +/- 11 years. The age of the patients with perforated duodenal ulcer was 48 +/- 12.5 and in hemorrhagic patients 37.4 +/- 8.6 years. Perforation with hemorrhagic duodenal ulcer in the first period was 1.2% and in second period, 0.2%. In the second period, simple closure was done in 29 (74%) patients, and in perforated DU cases, conservative management was done in 23 (56%) patients. Conclusion: Although the number of complicated duodenal ulcer cases increased from period I to period II, complications of duodenal ulcer (Kissing disease) significantly decreased.