Submited on: 17 Apr 2015 03:44:14 PM GMT
Published on: 20 Apr 2015 12:51:09 PM GMT
 
Case Report Diagnostic laparoscopy for missed perforated duodenal ulcer
Posted by Dr. Prem Kumar on 23 May 2015 08:23:38 AM GMT Reviewed by WMC Editors

  • What are the main claims of the paper and how important are they?

    Diagnostic laparoscopy offers the potential advantage of visually excluding or confirming the diagnosis of acute intra-abdominal pathology expeditiously without the need for a laparotomy.. It is the most accurate method even compared to open laparotomy , recommended and accepted worldwide. The main advantage of diagnostic laparoscopy over traditional open laparotomy is reduced morbidity, decreased postoperative pain, and a shortened length of hospital stay.It is safe well tolerated and can be performed in an outpatient and inpatient setting under general anesthesia.

    Non-operative treatment has been shown to be safe and effective in selected patients, although, it is difficult to predict reliably of those who will respond successfully. It is known that perforated ulcers frequently seal spontaneously by the adherence of the omentum of organs adjacent to the ulcer.

     Radiological investigations can be misleading. It is crucial to have high index of suspicion for complications of perforated ulcer, in order to manage them appropriately. Thus, appropriate clinical decision making should not be delayed by suboptimal imaging. Plain abdominal imaging harbors a substantial risk for false negative results.


  • Are these claims novel? If not, please specify papers that weaken the claims to the originality of this one.

    IOn their discusion the authors have stated that perforation of a peptic ulcer is potentially fatal surgical emergency that remains a formidable health burden worldwide. The consrvative treatment for duodenal ulcer must be done judicioiusly and patient specific.X ray showing gas under diahragm without signs of peritonitis can be treated conservatively.Even sealed perforation with signs of peritonitis requires laparotomy or laparoscopy to drain the peritoneal cavity.Laparoscopy cannot diagnose posterior perforation of stomach into lesser sac where the laprotomy is more beneficial.CT scan is more aquarate than plain x ray in diagnosing perforated duodenal ulcer.When in doubt air can be injected into the Ryle's tube and repeat imaging will show gas under diaphragm.


  • Are the claims properly placed in the context of the previous literature?

    As it is single case report, the inference from this article must be followed carefully.


  • Do the results support the claims? If not, what other evidence is required?

    As it is single case report, the inference from this article must be followed carefully.


  • If a protocol is provided, for example for a randomized controlled trial, are there any important deviations from it? If so, have the authors explained adequately why the deviations occurred?

    As it is single case report it is not applicable.


  • Is the methodology valid? Does the paper offer enough details of its methodology that its experiments or its analyses could be reproduced?

    As it is single case report it is not applicable.


  • Would any other experiments or additional information improve the paper? How much better would the paper be if this extra work was done, and how difficult would such work be to do, or to provide?

    Study can be done with 30 to 50 patients and then the paper can be represented with fresh evidence.


  • Is this paper outstanding in its discipline? (For example, would you like to see this work presented in a seminar at your hospital or university? Do you feel these results need to be incorporated in your next general lecture on the subject?) If yes, what makes it outstanding? If not, why not?

    Can be presented in the hospital meet to highlight the falicy in the different investigations and importance in the clinical examination


  • Other Comments:

    Nil

  • Competing interests:

  • Invited by the author to review this article? :
    Yes
  • Have you previously published on this or a similar topic?:
    No
  • References:
    None
  • Experience and credentials in the specific area of science:

    Practising surgeon and professor of surgery in medical college for 35 years.

  • How to cite:  Kumar P .Case Report Diagnostic laparoscopy for missed perforated duodenal ulcer [Review of the article 'Diagnostic laparoscopy for missed perforated duodenal ulcer; case report ' by Al Adwani M].WebmedCentral 2015;6(5):WMCRW003221
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Diagnostic Laparoscopy for missed perforated duodenal ulcer, case report
Posted by Dr. Dnyanesh Belekar on 18 May 2015 12:38:35 AM GMT Reviewed by WMC Editors

  • What are the main claims of the paper and how important are they?

    Use of diagnostic laparoscopy for missed perforated duodenal ulcer


  • Are these claims novel? If not, please specify papers that weaken the claims to the originality of this one.

    Yes


  • Are the claims properly placed in the context of the previous literature?

    Yes


  • Do the results support the claims? If not, what other evidence is required?

    Yes


  • If a protocol is provided, for example for a randomized controlled trial, are there any important deviations from it? If so, have the authors explained adequately why the deviations occurred?

    Not applicable


  • Is the methodology valid? Does the paper offer enough details of its methodology that its experiments or its analyses could be reproduced?

    Not applicable


  • Would any other experiments or additional information improve the paper? How much better would the paper be if this extra work was done, and how difficult would such work be to do, or to provide?

    No


  • Is this paper outstanding in its discipline? (For example, would you like to see this work presented in a seminar at your hospital or university? Do you feel these results need to be incorporated in your next general lecture on the subject?) If yes, what makes it outstanding? If not, why not?

    No


  • Other Comments:

    No

  • Invited by the author to review this article? :
    Yes
  • Have you previously published on this or a similar topic?:
    No
  • References:
    None
  • Experience and credentials in the specific area of science:

    I have treated similar cases in last 15 years.

  • How to cite:  Belekar D .Diagnostic Laparoscopy for missed perforated duodenal ulcer, case report[Review of the article 'Diagnostic laparoscopy for missed perforated duodenal ulcer; case report ' by Al Adwani M].WebmedCentral 2015;6(5):WMCRW003218
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Diagnostic laparoscopy for missed perforated duodenal ulcer; case report
Posted by Dr. Aswini Misro on 04 May 2015 02:40:42 PM GMT Reviewed by WMC Editors

  • What are the main claims of the paper and how important are they?

    Diagnostic laparoscopy is better than laparotomy. Should be used when clinical index of suspicion is high and radiology investigations are inconclusive/equivocal.

     

    Not groundbreaking discoveries. As thr authors have mentioned they have been used for diagnostic purpose since 1950s and 1960s.


  • Are these claims novel? If not, please specify papers that weaken the claims to the originality of this one.

    http://www.sciencedirect.com/science/article/pii/S2210261211001088

    Quesion remains was the diagnostic intervention warranted?

    Did this invasive intertvention change the overall management of the patient?

    If the 'nature' has sealed the perforation, then the aim of the treatmnent is reduced a supportive role with intervention only to address the complication e.g. drainage of subphrenic abscess, laparoscopic washout.


  • Are the claims properly placed in the context of the previous literature?

    As above


  • Do the results support the claims? If not, what other evidence is required?

    The claims are not something original.


  • If a protocol is provided, for example for a randomized controlled trial, are there any important deviations from it? If so, have the authors explained adequately why the deviations occurred?

    NA


  • Is the methodology valid? Does the paper offer enough details of its methodology that its experiments or its analyses could be reproduced?

    NA


  • Would any other experiments or additional information improve the paper? How much better would the paper be if this extra work was done, and how difficult would such work be to do, or to provide?

    A lierture review of radiology & conservastive management vs lapaorscopy in managment of GI perforation. Indication of diagnostic laparoscopy in acute abdomen(esp in GI perf.) would have added to the value of the paper.


  • Is this paper outstanding in its discipline? (For example, would you like to see this work presented in a seminar at your hospital or university? Do you feel these results need to be incorporated in your next general lecture on the subject?) If yes, what makes it outstanding? If not, why not?

    Not at all


  • Other Comments:

    Pictures are not of good resolution.

  • Competing interests:
    .
  • Invited by the author to review this article? :
    Yes
  • Have you previously published on this or a similar topic?:
    No
  • References:
    None
  • Experience and credentials in the specific area of science:

    Yes

  • How to cite:  Misro A . Diagnostic laparoscopy for missed perforated duodenal ulcer; case report [Review of the article 'Diagnostic laparoscopy for missed perforated duodenal ulcer; case report ' by Al Adwani M].WebmedCentral 2015;6(5):WMCRW003208
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