Peptic ulcer perforation associated with steroid use
M. T. Dayton, S. C. Kleckner and D. K. Brown
A ten-year (1974 to 1984) retrospective chart review was conducted to find
all patients with peptic ulcer perforation associated with steroid
treatment. During this period, 151 peptic ulcer perforations occurred, 25
(17%) associated with steroid use. Twenty patients had the diagnosis
confirmed at operation, five at autopsy. The most common operative
procedure was oversewing of the perforation with an omental patch (ten
cases). Postoperative complications occurred in 16 patients and were
multiple in 11. Underlying malignant neoplasms were the most common
concurrent disease (11 patients), five patients having brain metastasis. Of
25 patients, 15 died--five preoperatively and ten postoperatively. Patients
older than age 50 years had an overall mortality of 85%; those younger than
age 50 years, 17%. A recurring pattern in 21 patients was perforation
occurring after a major increase in steroid dose (pulse). Ulcer
perforations associated with steroid use constitute a significant portion
of all ulcer perforations, are lethal in most patients older than age 50
years, and are often associated with a steroid pulse before perforation.
