Clinico-pathological pattern and early post-operative complications of gastro-duodenal perforations at Mulago Hospital Kampala- a prospective cohort study

Abstract

Background: Gastro-Duodenal Perforations are one of the commonest causes of mortality and morbidity in conditions that require emergency surgery. The main objective of this study was to determine the clinico-pathological pattern and evaluate factors for early postoperative complications of Gastro-duodenal perforations in Mulago. Methods: This was a prospective cohort study of patients with gastro-duodenal perforations managed by simple repair between September 2014 and April 2015 in Mulago was studied. Primary/ secondary outcomes were mortality and complications respectively. Data was managed using stata-12 and multivariate analysis using log-binomial regression model. Results: A total of 65 patients were operated for Gastro-duodenal perforations in the study period. 86.2% were male (M: F 6.2:1). Median age was 35 years (range 16-80 years). 93.9% had gastric perforations. Clinical diagnosis was predicted in 89.3%. H. pylori was present in 7.9%. Mortality was 18.5% and complications developed in 58.5%. Age above 35 and presence of co morbidity predicted mortality (CI 1.22-21.12, p= 0.009) (CI 1.26-8.82, p= 0.024) and early post-operative complications (CI 1.03-2.44, p= 0.031) (CI 1.23-2.44, p= 0.011) respectively. Conclusion: Gastroduodenal perforations remain a common surgical emergency in Mulago hospital affecting mainly young men below 35 years. Majority are gastric perforations. Mortality and early post-operative complications are high, and increase with age and presence of co morbidity.

Comparison of QSOFA and sirs scores for the prediction of adverse outcomes of secondary peritonitis among patients admitted on the adult surgical ward in a tertiary teaching hospital in Uganda: a prospective cohort study

“…There were more males compared to females in this study. A similar observation has been reported by previous studies [3,[9][10][11][12][13][14][15].…”

Bacterial profile and antibiotic susceptibility patterns in patients with secondary peritonitis: a cross-sectional study in Uganda

“…A patient who took 3 days or more to come to hospital after onset of symptoms was also found to be 2.957(CI = 1.232–7.099, p = 0.015) times more likely to have secondary peritonitis compared to the one who presented in less than 3 days which is in agreement with a study done in Mbarara Regional Referral Hospital (Mutiibwa and Tumusiime 2013 ). Other studies by Nansubuga et al ( 2016 ) at Mulago National Referral Hospital, Mabewa et al ( 2015 ) in Tanzania, and Ndayizeye et al ( 2000 ) in Rwanda also had similar findings suggesting that late presentation could reflect delay in seeking health care, attempted treatment through a traditional healer, lack of resources for transport to the health facility and late referral by the peripheral health facilities. In some African settings, late presentation (beyond 24 h of the onset of the symptom) has been the norm, as seen at the study center.…”

Thirty-day postoperative outcome of patients with non-traumatic gastroduodenal perforations in southwestern Uganda

“…In Uganda, patients tend to present late for healthcare. 13 Delays were attributed to distance from our surgical centre or delay at health facilities before referral to Mbarara Regional Referral and Teaching Hospital.…”