Clinical presentation and surgical management of perforated peptic ulcer in a tertiary hospital in Mogadishu, Somalia: a 5-year retrospective study

Abstract

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.

Operative versus non-operative management for perforated peptic ulcer disease

“…Perforated peptic ulcer (PPU) is a common surgical emergency. Over the last 50 years, although there has been a dramatic fall in the prevalence of peptic ulcer disease (PUD) due to use of treatment for elimination of Helicobater pylori, the number of patients needing surgery has remained mostly unchanged [ 2 , 3 ].…”

Laparoscopia versus laparotomia na Úlcera Péptica Perfurada: revisão de literatura dos últimos cinco anos

“…Uma cultura do líquido peritoneal em pacientes que tiveram abscesso após laparotomia encontrou os micro-organismos E. coli, Klebsiella, pseudomonas, Staphylococcus aureus e Candida spp. Porém, metade dos pacientes com cultura de líquido peritoneal, nenhum crescimento de micro-organismos foi observado (ALI et al, 2022).…”

Clinical Characteristics of Peptic Ulcer Disease & its Pharmacological Management in Primary Care

“…Peptic ulcer disease (PUD) is a common condition that affects 4 million people throughout the world annually. 1,2 The incidence has been estimated at around 1.5% to 3%. 1,2 Lifetime prevalence is reported to be approximately 5%-10%.…”

“…1,2 The incidence has been estimated at around 1.5% to 3%. 1,2 Lifetime prevalence is reported to be approximately 5%-10%. 1,3,4 PUD includes both ulcerations and erosions in the stomach and duodenum which develops due to an imbalance between defensive mechanisms such as a mucus-bicarbonate layer, prostaglandins, cellular renovation, and blood of PUD.…”

“…2,3,5,6 Historically, this imbalance is predominantly associated with the use of non-steroidal anti-inflammatory drugs (NSAIDs) and acetylsalicylic acid (ASA) and/or Helicobacter pylori infection. [1][2][3][6][7][8] Gastric acid hypersecretion, psychological stress, nicotine and/or alcohol consumption, immunosuppressive medication, and age-related decline in prostaglandin levels are other important risk factors for the development Abstract Background: Peptic ulcer diseases (PUD) are common conditions reported in daily clinical practice. Proton pump inhibitors (PPIs) are the most potent pharmacological inhibitors of gastric acid secretion.…”