ORIGINAL ARTICLE

Bali Medical Journal (Bali Med J) 2016, Volume 5, Number 1: 166-168

P-ISSN.2089-1180, E-ISSN.2302-2914

Characteristic of gastric perforation type

and the histopathology at Haji Adam Malik
general hospital Medan-Indonesia CrossMark

Published by DiscoverSys Kamsir Koto,1* Asrul,2 Muradi A2

ABSTRACT

Background: According to BPPK of health department in 2008, years old and the least frequent age group was 40-46 years old and 75-
gastric ulcers ranks 10 in cause of mortality on male with age group 81 years old. 28 subjects were patients with type 3 gastric perforation
45-54 at Indonesia. To date, there is no report of gastric perforation and no type 2 gastric perforation was found. Histopathology
characteristic at Haji Adam Malik General Hospital Medan. examination revealed that no malignancy was found. Majority of
Methods: This is a non-experimental study with descriptive subjects both in male and female use NSAID.
retrospective design. Data retrieved from patients’ medical record with Conclusions: Majority of subjects was male. The most frequent
diagnosis of gastric perforation at Haji Adam Malik General Hospital age group with gastric perforation was 47-53 and 61-67 years
Medan on January 2011-December 2014. old. The most frequent type of gastric perforation was type 3.
Results: Majority of patients involved in this study was male with 44 Histopathology examination showed that all subjects were with
subjects (78.6%), while female was 12 subjects (21.4%). The most chronic inflammation.
frequent age group with gastric perforation was 47-53 and 61-67

Keywords: perforation, gastric.

Cite This Article: Koto, K., Asrul, A., A, M. 2016. Characteristic of Gastric Perforation Type and The Histopathology at Haji Adam Malik General
Hospital Medan-Indonesia. Bali Medical Journal 5(1): 166-168. DOI:10.15562/bmj.v5i1.325

1
Surgery Resident, Faculty of INTRODUCTION Perforation most often found at pre-pyloric
Medicine University of North (40%), duodenum (28%), and antrum (5%).8
Sumatra/Haji Adam Malik General Nearly 4 million people worldwide are diagnosed Gastric perforations which caused by gastric carci-
Hospital, Medan-Indonesia with peptic ulcer every year.1 Complications occur noma rarely occur. The incidence of gastric perfo-
2
Digestive Surgery Consultant, in 10-20% of patients, while 2-14% of the patients
Faculty of Medicine University ration caused by gastric carcinoma is 5%. Majority
of North Sumatra/Haji Adam will progress to perforation.2 More than half of of the patients are in advanced stage (64-88%).9
Malik General Hospital, Medan- cases are female.2,3 Perforation which caused by gastric malignancy
Indonesia Gastric perforation may develop to chemical generally found at greater curvature (77%).10 To
peritonitis caused by leakage of gastric acid into date, there is no report concerning characteristic
abdominal cavity. All form of perforation in gastro- of gastric perforation type at Haji Adam Malik
intestinal is a surgical emergency case. Perforation General Hospital.
is not a frequent complication in patients with
gastric ulcers.4 It occurs as a result of broad anti-­
inflammatory drugs usage.5
The most frequent etiology of gastric perforation
METHODS
is peptic ulcer and 10-15% of patients with peptic Non-experimental study with retrospective
ulcer may develop into perforation. In perforation descriptive design was conducted at surgery
of gastric ulcer, 6-14% of cases are caused by malig- department, digestive surgery division of Haji
nancy, in contrast with duodenal ulcer where the Adam Malik General Hospital Medan. All data
incidence of malignancy is found in almost zero obtained from patients’ medical record with diag-
cases.6 nosis of gastric perforation at Haji Adam Malik
The major factors include the use of nonsteroi- General Hospital Medan from January 2011 until
*
Correspondence to: Kamsir Koto, dal anti-inflammatory drugs (NSAID), helicobacter December 2014. Population in this study was all
Address: Surgery Resident, Faculty pylori infection, and malignancy. At Indonesia, patients with gastric perforation at Haji Adam
of Medicine University of North
Sumatra/Haji Adam Malik General
gastric ulcer ranks 10 as mortality cause on male Malik General Hospital Medan from January 2011
Hospital, Medan-Indonesia with age of 45-54 years old, according to BPPK of until December 2014. Total sampling method was
kamsirfia@gmail.com health department on 2008.7 used for sample selection in this study. Inclusion

166 Open access: www.balimedicaljournal.org and ojs.unud.ac.id/index.php/bmj

 ORIGINAL ARTICLE

criteria was all medical record data with diagnosis Table 1  Characteristics of subjects
of gastric perforation with histopathology exam-
Characteristics Frequency %
ination results at digestive surgery division of
Haji Adam Malik General Hospital Medan from Gender
January 2011 until December 2014. Patients with Male 44 78.6
Female 12 21.4
gastroduodenal perforation caused by trauma and
without histopathology examination result were Age
excluded. 40-46 4 7.1
All data obtained from patients’ medical record. 47-53 13 23.2
54-60 10 17.9
Type of gastric perforation divided into 4 types.
61-67 13 23.2
Type 1 or primary type located on lesser curvature 68-74 12 21.4
between fundus and antrum of gastric. Type 2 is a 75-81 4 7.1
combination of gastric ulcer and duodenal ulcer
Ethnic
which located at lesser curvature and duodenal.
Batak 20 35.7
Type 3 located at pre-pyloric. Type 4 located at Javanese 14 25
juxtaesophageal which higher from lesser curvature Malays 6 10.7
close to gastroesophageal junction. Histopathology Aceh 9 16.1
examination was done at pathology anatomy divi- Karo 6 10.7
sion. Malignancy was determined if microscopi- Minang 1 1.8
cally recognized as adenocarcinoma with various Type of perforation
degree of differentiation, linitis plastica which Type 1 24 42.9
known as anaplastic with manifestation of bizarre Type 2 0 0
cells surrounded by fibrosis, signet-ring cell carci- Type 3 28 50
noma. History of NSAID use defined as history of Type 4 4 7.1
all nonsteroidal anti-inflammatory drug consumed Histopathology
by patients. Chronic inflammation 56 100
All data were analyzed descriptively and Malignancy 0 0
presented in tables and diagram. Tables and
diagram were explained in narrative.
Table 2  F
 requency of NSAID usage both in
male and female
RESULTS Variable Male (n=44) Female (n=12)
A total of 56 patients with gastric perforation, NSAID usage, n (%)
obtained from patients’ medical record at Haji NSAID (+) 37 (84.1) 2 (16.7)
Adam Malik General Hospital from January 2011 NSAID (-) 7 (15.9) 10 (83.3)
until December 2014, were enrolled in this study.
The characteristics which we analyzed in this study
DISCUSSIONS
were gender, age, perforation type, and histopathol-
ogy. The results are shown in table 1. Majority of subjects in this study was male (78.6%),
Majority of subjects in this study was male while female was 12 subjects (21.4%). This result
(78.6%), while female was 21.4%. The most frequent similar with previous research in India which
age group with gastric perforation was 47-53 and showed that comparison of male and female with
61-67 years old and the least frequent age group gastric perforation was 4:1.2 Other study by Gupta
was 40-46 years old and 75-81 years old. The most et al found similar result in which comparison of
frequent ethnic group with gastric perforation was male and female with gastric perforation was 10:1.11
Batak ethnic with 20 subjects (35.7%). 28 subjects The most frequent age group with gastric perfo-
(50%) were diagnosed with type 3 gastric perfora- ration was 47-53 and 61-67 years old and the least
tion and no type 2 gastric perforation was found. frequent age group was 40-46 years old and 75-81
Histopathology examination found that all subjects years old. It is in accordance with previous theory
were with chronic inflammation (100%), no malig- which stated that gastric ulcer rarely occurs below
nancy was found. 40 years old, and its peak incidence is between
Majority of both male and female was using 55 and 65 years old. Gastric ulcer often occurs in
NSAID (37 subjects and 10 subjects, respectively), people with low socioeconomic status. Pathogenesis
as major risk factor of gastric ulcers. The results of benign gastric ulcer is remains unknown. Several
presented in table 2. conditions may become predisposing factor for

Published by DiscoverSys | Bali Med J 2016; 5 (1): 166-168 | doi: 10.15562/bmj.v5i1.325 167
ORIGINAL ARTICLE

gastric ulcer, for instance age more than 40 years with protease release. Oxygen free radicals resulted
old.12 All patients treated in Haji Adam Malik in epithelial and endothelial damage which caused
General Hospital are more than 40 years old. It may stasis of microvascular flow, lead to ischemia and
be caused by NSAID consumption, which often peptic ulcer. The incidence of gastric perforation
used as pain killer medicine by people. was reported as 5%, and majority of patients was in
This study found that 28 subjects had type 3 advance stage (64-88%).9
gastric perforation (50%) and no subjects had type
2 gastric perforation. This result is in accordance
CONCLUSIONS
with previous theory. Gastric ulcer may develop
anywhere in gastric. Perforation divided into 4 Majority of patients was male. The most frequent
types. Type 1 (primary) located on lesser curvature age group with gastric perforation was 47-53 and
between fundus and antrum of gastric, commonly 61-67 years old. The most frequent type of gastric
occur in elderly and associated with hyposecretion perforation was type 3. Histopathology exam-
of gastric acid. Type 2 is the combination of gastric ination shows that all subjects were with chronic
ulcer and duodenal ulcer which located at lesser inflammation.
curvature and duodenal and it is very rare. Type
2 and type 3 occur in younger patients with high
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168 Published by DiscoverSys | Bali Med J 2016; 5 (1): 166-168 | doi: 10.15562/bmj.v5i1.325