A review of the management of perforated duodenal ulcers at a tertiary hospital in south western Nigeria

Etonyeaku, Amarachukwu Chiduziem; Agbakwuru, E A; Akinkuolie, AA; Omotola, CA; Talabi, A. O.; Onyia, C. U.; Kolawole, O J; Aladesuru, OA

doi:10.4314/ahs.v13i4.7

Cited by 12 publications

(18 citation statements)

References 23 publications

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“…For example, African cohorts from Nigeria, Kenya, Ethiopia, Tanzania and Ghana report of male rates from 6 to 13 times that of females, median age in the 40s, and a predominant duodenal location in up to 90%. 17 – 21 Similar patterns are reported from the middle East and Arab countries and parts of southern Asia. 22 – 25 …”

Section: Epidemiology Of Peptic Ulcer Disease and Its Complicationssupporting

confidence: 75%

Perforated peptic ulcer

et al. 2015

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SummaryPerforated peptic ulcer (PPU) is a frequent emergency condition worldwide with associated mortality up to 30%. A paucity of studies on PPU limits the knowledge base for clinical decision-making, but a few randomised trials are available. While Helicobacter pylori and use of non-steroidal anti-inflammatory drugs are frequent causes of PPU, demographic differences in age, gender, perforation location and aetiology exist between countries, as do mortality rates. Clinical prediction rules are used, but accuracy varies with study population. Early surgery, either by laparoscopic or open repair, and proper sepsis management are essential for good outcome. Selected patients can perhaps be managed non-operatively or with novel endoscopic approaches, but validation in trials is needed. Quality of care, sepsis care-bundles and postoperative monitoring need further evaluation. Adequate trials with low risk of bias are urgently needed for better evidence. Here we summarize the evidence for PPU management and identify directions for future clinical research.

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Section: Epidemiology Of Peptic Ulcer Disease and Its Complicationssupporting

confidence: 75%

Perforated peptic ulcer

et al. 2015

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“…This was similar to the observation in Ile-Ife and other Centres. [17][18][19] Everett et al in their study of 136 patients observed sex ratio of 6.5:1 with only 18 female patients, this study agrees with the result of present study of men predominance in perforated peptic ulcer cases and this was in agreement with the findings of other studies where the male to female ratio ranged from 3.3:1 to 9:1. [20][21][22] Svanes was of the view that in men, ulcer perforation incidence increased until about 1950 and declined thereafter.…”

Section: Discussionsupporting

confidence: 83%

Clinical study of open versus laparoscopic management for gastroduodenal perforation

et al. 2017

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Background: This study was organized to compare the clinical efficacy of laparoscopic and open repair of gastroduodenal perforation, and to provide the impressive surgical method of treatment for gastroduodenal perforation.Methods: The present study was conducted with 174 consecutive patients treated for gastroduodenal perforations. These patients included 121 with perforated gastric ulcers, 53 with perforated duodenal ulcers, Whereas 31 patients were treated laparoscopically, and 143 patients underwent conventional (open) surgery.Results: A total of 174 patients were studied with men and women ratio of 4:1. This observational study revealed 80% male preponderance, with mean age of 48 years. Gastric perforations (n=77, i.e., 84.62%) were more common than duodenal perforations (n=14, i.e., 15.38%). Simple closure with omental patch (n=74, i.e., 81.32%) was the most common surgical method for duodenal perforation. While for gastric perforations were repaired primarily with two layered sutures. The mean operating time of open were 61 min and 86 min for laparoscopic surgery. Wound infection was the commonest post-operative complication which was seen in 31 (17.81%) patients.Conclusions: Laparoscopic gastroduodenal perforation repair is safe and reliable, has good clinical efficacy, the incidence of complications compared with open surgery does not increase, and has less surgical trauma, less bleeding, advantages of fast recovery of gastrointestinal function and short hospitalization time, Thus it has great clinical significance and should be promoted in surgery.

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“…Leak rates of 2-8% have been reported after perforation repair. 19,21,22 In the present study the fistula rate was 5%. These unfortunate patients have a 35% chance of mortality.…”

Section: Discussionsupporting

confidence: 48%

“…Etonyeaku et al from Nigeria reported 10:1, Chalya et al from Tanzania found a 13:1 ratio while Bali et al from India showed a ratio of 5:1. 19,20,28 The acid reducing procedures (vagotomy/ highly selective vagotomy) are used infrequently and in special circumstances only (e.g. in giant ulcers).…”

Section: Discussionmentioning

confidence: 99%

The outcome of surgery for perforated peptic ulcer in modern times

Vats¹,

Rehmani²,

Agrawal³

2018

Int Surg J

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Background: A laparotomy for peritonitis due to perforated peptic ulcer is one of the commonest emergency operations done by a general surgeon and is still associated with a marked mortality and morbidity. The aim was to assess the current mortality and morbidity in patients operated for perforated peptic ulcer and to identify the factors associated with increased mortality in these patients.Methods: All adult patients operated for perforated peptic ulcer over a period of one year were included in this prospective observational study. The demographics, clinical presentation, pre-operative laboratory parameters, operative findings, operation done, and the outcomes were noted in pre-designed proforma. Mortality and morbidity was assessed and factors relating to increased mortality were determined using standard statistical tests of significance such as Chi square test and the student’s t test.Results: 55 patients underwent laparotomy for perforated peptic ulcer (23 gastric and 32 duodenal perforations). There were 53 males and only 2 females in the group. Their mean age was 44 years. The mortality was 16% (9/55) and morbidity was 25% (14/55). Complications were encountered in 14 patients, most commonly surgical site infection in 13% cases, entero-cutaneous fistula occurred in 3 patients and one of them expired despite re-exploration due to persistent sepsis. The other two patients survived, and fistula healed spontaneously. The operative procedure done was Graham’s patch or it’s modification. Only 2 patients had antrectomy with Billroth II reconstruction.Conclusions: Despite the advances in management of critically ill patients, the mortality (16%) and morbidity (25%) for this common surgical emergency remains high and is unchanged over the last half century. Presence of comorbidities and low serum albumin are associated with an increased risk of adverse outcome.

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A review of the management of perforated duodenal ulcers at a tertiary hospital in south western Nigeria

Cited by 12 publications

References 23 publications

Perforated peptic ulcer

Perforated peptic ulcer

Clinical study of open versus laparoscopic management for gastroduodenal perforation

The outcome of surgery for perforated peptic ulcer in modern times

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