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Merril T. Dayton, MD; Steven C. Kleckner, MD; Dennistoun K. Brown, MD

Arch Surg. 1987;122(3):376-380.

Abstract
• 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 (1) constitute a significant portion of all ulcer perforations, (2) are lethal in most patients older than age 50 years, and (3) are often associated with a steroid pulse before perforation.

(Arch Surg 1987;122:376-380)

Author Affiliations
From the Department of Surgery, University of Iowa Hospitals and Clinics, Iowa City, and the Iowa City Veterans Administration Medical Center. Dr Dayton is now with the Salt Lake City Veterans Administration Medical Center.

Footnotes
Accepted for publication Oct 22, 1986.

Read before the Tenth Annual Surgical Symposium of the Association of Veterans Administration Surgeons, Washington, DC, May 10, 1986.

Reprint requests to Surgical Services, Salt Lake City Veterans Administration Medical Center, 500 Foothill Blvd, Salt Lake City, UT 84148 (Dr Dayton).

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