الفهرس 
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Abstract
SUMMARY
erforated duodenl ulcer (PPU) is the most common
indication for emergency gastric operation. Perforation
occurs in about 2-10% of peptic ulcers and of these about 60%
are duodenal. The original of PPU seem to be multifactorial,
but most are associated with nonsteroidal anti-inflammatory
drugs (NSADS) and Helicobacter pylori (HP) infection. The
vast majority of PPU patients require emergency operation.
Promot diagnosis of gastroduodenal perforation requires
a high index of suspicion based on history and clinical
examination. Patients with gastroduodenal perforation usually
present with abdominal pain and peritoneal irritation from
leakage of acidic gastric contents. At physical examination
pulse might be quickened, but seldom goes beyond 90 beats per
minute. About 5-10% of patients experience shock with a mean
arterial pressure of less than 80 mmHg. Hypotension is a late
finding as is high fever.
Imaging choice for diagnosing bowel perforations
include plain films and computed tomography. An upright chest
x-ray is an excellent first choice. A positive upright chest x-ray
(free air beanth the diaphragm) can acutely make the diagnosis.
Laboratory studies are not useful in that acute setting as they
tend to be nonspecific, but leukocytosis, metabolic acidosis,
and elevated serum amylase may be associated with
perforation.
P
Perforated peptic ulcer can be treated by using a wide
range of options, which varies from conservative non-operative
treatment to imediate defintive ulcer surgery. Some patients
with perforated ulcer can be managed successfully by nonoperative
means. However, in many cases the uncertainty of the
exact underlying pathology and diagnosis can determined from
this line of management.
Acid reduction surgery is now being replaced by simpler
procedures, such as primary closure of the perforation, owing to
better understanding of the pathophysiology of peptic ulcer
diseases and the improvement in anti-ulcer medications Simple
closure remains an attractive for perforated duodenal ulcer in
most centers and hence that laparoscope is gradually gaining
popularity to treat perforated duodenal ulcer.
Nathanson et al. and Mouret et al. reported laparoscopic
treatments of perforated peptic ulcer in 1990 for the first time.
Following these reports, perforated peptic ulcer treatment by
laparoscopy has gained popularity. There have bee several
reports of successful laparoscopic repairs of perforated peptic
ulcers, because laparoscopy provides a better vision of the
peritoneal cavity and avoids an unnecessary laparotomy,
allowing for the repair of the perforation and adequate
peritoneal lavage without a large upper-abdominal incision.
Furthermore, the procedure has been reported to have less
postoperative pain, the opportunity for early mobilization, and a
reduction of postoperative complications.
Despite the rapid increase in laparoscopic experience,
controversies of the laparoscopic treatment of perforated peptic
ulcer continue because of some concerns about a longer operation
time, equivocal postoperative effectiveness, leakage, and high rate
of reoperation. These disadvantages of laparoscopic treatment can
likely be attributed to the facts that the surgeons have less
experience, laparoscopic repair with an omental patch and
irrigation of the peritoneal cavity are difficult, and take a long
time.
But with efforts to develop new instruments and new
trends to avoid drawbacks of laparoscope in management of
perforated duodenal ulcer laparoscope is now being more safe
and more reliable.