Peptik ülser perforasyonu tanısını koymada X-ray filminin etkinliği

Year 2024, Volume: 49 Issue: 2, 363 - 370, 30.06.2024

Cengiz Ceylan Zafer Bilen Cemalettin Aydın

https://doi.org/10.17826/cumj.1431057

Abstract

Amaç: Peptik ülser perforasyonu (PUP) tanısında X-Ray filminin etkinliğini araştırmak amacıyla retrospektif bir vaka-kontrol çalışması tasarlandı.
Gereç ve Yöntem: Çalışmaya dahil edilen 353 hastanın demografik verileri, perioperatif bulguları ve postoperatif bulgularına hastane veritabanından ulaşıldı. X-Ray filminde intraperitoneal serbest hava durumuna göre iki grup oluşturuldu.
Bulgular: Popülasyonunun median yaşı 57’idi (IQR 38-71) ve hastaların %82.4'ü erkekti. X- Ray filminde hastaların %73.1'inde intraperitoneal serbest hava gözlemlendi. Gruplar arasında, multivariate analizlerde yalnızca zaman ve diabetes mellitus (DM) bağımsız risk faktörlerleriydi. Semptomların başlangıcı ile acil servise başvurunun arasındaki süre uzadıkça X-ray filminin duyarlılığının arttığı, DM'nin varlığında özgüllüğünün arttığı gözlemlendi.
Sonuç: PUP tanısında klinik değerlendirmeye ek olarak yardımcı görüntüleme yöntemlerinin gerekliliği açıktır. Ancak, X-Ray filminin hassasiyet ve özgüllüğündeki DM'ye bağlı değişkenlik ve semptom başlangıcından acil servise başvuruya kadar geçen süre dikkate alınmalıdır. Özellikle intraperitoneal serbest hava olmaksızın PUP şüphesi bulunan hastalarda, ileri tanısal yöntemlerin kullanımı önerilir.

Keywords

Peptik ülser perforasyonu, X ışını Filmi, etkinlik

Effectiveness of X-ray film in diagnosing peptic ulcer perforation

Abstract

Purpose: A retrospective case-control study was undertaken to assess the diagnostic efficacy of X-ray film in detecting peptic ulcer perforation (PUP).
Materials and Methods: The study retrieved demographic data, perioperative observations, and postoperative results of 353 patients from the hospital repository. These individuals were categorized into two cohorts depending on the detection of intraperitoneal free air on X-ray imaging.
Results: The study cohort exhibited a median age of 57 years (interquartile range: IQR 38-71), comprising predominantly males (82.4%). Intraperitoneal free air was evident in 73.1% of patients on X-ray imaging. In the multivariate analyses of the respective groups, time interval and diabetes mellitus (DM) emerged as independent risk factors. Notably, the sensitivity of X-ray film heightened with prolonged duration between symptom onset and emergency department admission, while specificity increased in the presence of DM.
Conclusion: The imperative for supplementary imaging modalities in conjunction with clinical assessment is apparent in the diagnostic approach to PUP. Nonetheless, the fluctuation in sensitivity and specificity of X-ray film concerning DM and the duration from symptom onset to emergency department admission warrants careful consideration. Especially in cases where clinical suspicion of PUP exists despite the absence of intraperitoneal free air on X-ray, the utilization of advanced diagnostic techniques is advocated.

Keywords

Perforated peptic ulcer, X-Ray film, efficiency

References

• Bertleff MJ, Lange JF. Perforated peptic ulcer disease: a review of history and treatment. Dig Surg. 2010;27:161-9.
• Lau JY, Sung J, Hill C, Henderson C, Howden CW, Metz DC. Systematic review of the epidemiology of complicated peptic ulcer disease: incidence, recurrence, risk factors and mortality. Digestion. 2011;84:102-13.
• Tarasconi A, Coccolini F, Biffl WL, Tomasoni M, Ansaloni L, Picetti E et al. Perforated and bleeding peptic ulcer: WSES guidelines. World J Emerg Surg. 2020;15:3.
• Cho KC, Baker SR. Extraluminal air: diagnosis and significance. Radiol Clin North Am. 1994;32:829–44.
• Grassi R, Romano S, Pinto A, Romano L. Gastro-duodenal perforations: conventional plain film, US and CT findings in 166 consecutive patients. Eur J Radiol. 2004;50:30-6.
• Søreide K, Thorsen K, Søreide JA. Strategies to improve the outcome of emergency surgery for perforated peptic ulcer. Br J Surg. 2014;101:51-64.
• Chen SC, Yen ZS, Wang HP, Lin FY, Hsu CY, Chen WJ. Ultrasonography is superior to plain radiography in the diagnosis of pneumoperitoneum. Br J Surg. 2002;89:351-4.
• Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004;240:205-13.
• Nouri D, Soleimanian Gj N, Ataei F, Mohammadi M. Effects of sex, age, size and location of perforation on the sensitivity of erect chest X-ray for gastroduodenal perforation. Radiography (Lond). 2021;27:1158-61.
• Boey J, Choi SK, Poon A, Alagaratnam TT. Risk stratification in perforated duodenal ulcers. A prospective validation of predictive factors. Ann Surg. 1987;205:22-6.
• Møller MH, Engebjerg MC, Adamsen S, Bendix J, Thomsen RW. The peptic ulcer perforation (PULP) score: a predictor of mortality following peptic ulcer perforation. A cohort study. Acta Anaesthesiol Scand. 2012;56:655-62.
• Rogers FA. Elevated serum amylase: a review and an analysis of findings in 1,000 cases of perforated peptic ulcer. Ann Surg. 1961;153:228-40.
• Terzioglu SG, Canlıkarakaya F, Ocaklı S, Ceylan C, Ağaçkıran İ, Akıncı F et al. The feasibility of falciformopexy in the repair of peptic ulcer perforation. Ulus Travma Acil Cerrahi Derg. 2023;29:1237-41.
• Chung KT, Shelat VG. Perforated peptic ulcer - an update. World J Gastrointest Surg. 2017;9:1-12.