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Results for “PEPTIC ULCER PERFORATION”

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PubMed1993

Spontaneous gastroduodenal perforation in patients with cancer receiving chemotherapy and steroids. Report of four cases combining 5-fluorouracil infusion and cisplatin with antiemetics dexamethasone.

BACKGROUND: Spontaneous gastroduodenal perforation is an uncommon but life-threatening complication of systemic chemotherapy and/or steroids. Here, the authors reported four cases of gastroduodenal perforation following combined chemotherapy with steroids. METHODS: The chemotherapeutic regimens all included 5-fluorouracil (5-FU) by continuous infusion and cisplatin. The authors used dexamethasone as an antiemetic. All patients took analgesics for pain relief. No patient had a history of peptic ulcer disease. RESULTS: Severe epigastralgia occurred 3-5 days after the start of chemotherapy. The peptic ulcer perforations were diagnosed within 3 days of onset of symptoms. All patients had an emergency laparotomy. Three of the perforations were located in the duodenum and one was located in the stomach. Pathologic examination of one patient revealed a chronic peptic ulcer. Two patients with preoperative shock died in the postoperative period. CONCLUSIONS: The cause of spontaneous gastroduodenal perforation is not known, but the etiology can be complex. Either 5-FU or steroids can induce the perforation. An asymptomatic peptic ulcer may be aggravated by 5-FU, cisplatin, or dexamethasone. The authors suggest that patients receiving 5-FU infusion and cisplatin with dexamethasone for antiemesis who complain of epigastric pain should be mentioned for a gastroduodenal ulcer or even a perforation.

Adult↗
PubMed1995

The acute abdomen in spinal cord injury individuals.

A review of 1300 patients with spinal cord injury (SCI), over a period of 14 years, revealed 12 patients with an 'acute abdomen'. Seven events occurred during the initial admission, ranging from 10 days to 9 months from injury, and five during readmission of 'chronic' SCI patients. Four were in the acute stage 10-30 days from injury, all with peptic ulcer perforations. The remainder had either an intestinal obstruction, appendicitis or peritonitis. All of the neurological levels were above T6 except for one patient who had a low level paraplegia. The classical signs of an 'acute abdomen' may be missing in such patients thus delaying diagnosis by 1-4 days. The most important signs were autonomic dysreflexia, referred shoulder tip pain, abdominal pain, abdominal distension, increased spasticity and abdominal pain with nausea and vomiting. Less importance was given to the classical signs of abdominal tenderness, abdominal muscle rigidity, rebound, fever and of leukocytosis. Prompt diagnosis and treatment will minimise morbidity and mortality.

Abdomen, Acute↗