Background Perforated peptic ulcer is a common surgical emergency condition worldwide, which is associated with significant morbidity and mortality if early diagnosis and immediate surgical management were not carried out. Perforation occurs in roughly 5% of PUD patients during their lifetime; this study aimed to explore the wide range of clinical presentations, associated risk factors, complications, and surgical management of perforated peptic ulcer patients. Methods A 5-year retrospective observational study on the clinical presentation and surgical management of perforated peptic ulcer is carried out in a tertiary hospital in Mogadishu, Somalia, Department of General Surgery, from January 2017 to December 2021. We included all patients undergoing operations with an intraoperative confirmed diagnosis of perforated peptic ulcer at the general surgery department. For operated patients, follow-up evaluation was performed in the outpatient department. Results Fifty-one patients underwent an emergency operation for perforated peptic ulcer during the study period. The sociodemographic distribution of patients was 45 (88.2%) males and 6 (11.8%) females, giving a male-to-female ratio of 7.5:1. The mean age of patients was 35.5 ± 16.8 years, and the peak frequency was in the third decade. The commonest presenting symptoms were sudden onset of severe epigastric pain in 42 (82.4%) patients. Patients who presented perforated peptic ulcer within 24 h of initiation of symptoms were free from complications. Age-group and delayed presentation > 48 h after onset of symptoms were linked to postoperative complications and were statistically significant (P 0.032 and P 0.005), respectively. Four patients died (mortality rate of 7.8%). Two patients were reoperated because of the failed primary repair, and 4 patients had > 5 cm intra-abdominal abscess image-guided percutaneous drainage, and the rest were given antibiotic therapy according to peritoneal fluid culture and sensitivity results. The most common microorganism isolated was E. coli 22% and Klebsiella 11%. Other rare microorganisms (pseudomonas, Staphylococcus aureus, and Candida spp.) were identified. In half (51%) of the patients with peritoneal fluid culture, no microorganism growth was seen. Conclusion The distribution of perforated peptic ulcer is common in the young age-group in the third decades of life. Delayed presentation of the disease is linked because most patients arrived from remote areas where proper facilities of health care and health education are not available and the patient might come to the hospital in an advanced stage of the disease. We suggest conducting further researches, health awareness related to complications over-the-counter drugs self-medication, and bad habit including smoking, and to improve health-seeking behaviors of society.

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Background: Intestinal obstruction is a potential surgical emergency condition with a high rate of morbidity and mortality. The most prevalent causes of intestinal obstruction in adults are adhesions, which are followed by incarcerated hernias and tumors. Methods: A three-year retrospective data study of adult patients treated with IO at the Mogadishu Somalia Turkey training and research hospital in Mogadishu, Somalia, between June 1, 2019, and June 1, 2022. Results: A majority (67%) of our study were male showing the male predominance of the disease with a male-to-female ratio of 2:1. The patients demonstrated a variety of signs and symptoms, but the most prominent manifestations were nausea and vomiting (93.2%), abdominal distension (90.2%), and failure to feces /flatus (70.8%). The majority of the patient 98(95.1%) with intestinal obstruction was treated under operative management, whereas conservative management (i.e., nasogastric tube decompression, intravenous antibiotics, and intravenous fluid resuscitation) was applied in 4.9% of cases. surgical site infections were the main cause of their postoperative complications, According to the patient's hospital stays, the majority of patient (52%) hospitalizations lasted between 8 and 14 days. the overall mortality rate in this study was 5(4.9%), Discussion: Intestinal obstruction is one of the most common life-threatening emergencies all over the world presenting as acute abdomen and requiring surgical admission and management, Surgeons should keep up their aggressive approach to the elective treatment of all abdominal hernias and prompt surgical intervention in patients who have acute mechanical intestinal obstruction caused by incarcerated hernias. According to Mr. Hamilton Bailey, The sun should not rise and set on an unresolved case of intestinal obstruction The mortality rate related to intestinal obstruction was associated with the late presentation of the disease. Conclusion: Small bowel obstruction is more frequent than large bowel obstruction in this study, fibrous adhesion and incarcerated hernia were the leading causes of small bowel obstruction. Adhesiolysis and resection of non-viable. Bowel resection and anastomosis were the most frequent intraoperative procedures. More research utilizing prospective study designs is recommended.

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