Gastro-duodenal peptic ulcer perforation

Abstract

Objectives:To determine the epidemiology of, and define the morbidity and mortality factors following emergency surgery for patients with perforated peptic ulcer disease in Accra, Ghana. Design: A retrospective and prospective hospital-based study. Setting: The general and paediatric surgical wards of the Korle-Bu Teaching Hospital. Main outcome measures: Demography, the systolic BP, pulse rate and haemoglobin on admission at ER, co-morbid conditions, site of perforation, surgical method and treatment outcome. Subjects: A total of 326 cases treated for peptic ulcer perforation, 267 males and 59 females; ratio 4.5:1, with mean age of 40.9, SD 16.4 and range 4-87 years, were studied. Results: The incidence of peptic ulcer perforation rose from 1.6% in 1998 to 5.3% in 2002 and stabilised at 5%, and overall accounted for 4.6% of acute abdomen. Co-morbid conditions were present in 48 (18.2%) of cases. Ulcerogenic substance intake was in 177 (67%) patients. One hundred and twenty two (46.2%) patients reported to hospital within 24 hours of perforation. There were 287 (88%) duodenal, 22 (7.1%) prepyloric, and 19(4.9%) type 1 gastric ulcer perforations. Simple closure with omental patch was performed in 299(94.3%), truncal vagotomy and drainage in 10 (3.2%), and Billroth II partial gastrectomy in seven (2.2%). Post-operative complications occurred in 62 (19%); overall mortality was 36 (11%). Logistic regression analysis of the patients clinical variables showed that age less that 60 years (p-value, OR and 95% CI; 0.002, 3.964 and 1 .668-9.420), duration of perforation of more than 24 hours before admission (p-value, OR and 95%CI; 0.011,2.471 and 1.228-4.971), alcohol intake (p-value, OR and 95%CI; 0.009, 2.543 and 1.259-5.135) and resectional surgery (p-value, OR and 95%CI; 0.000, 8.25E and 74204908.138-9162648048.1) were statistically significant in determining postoperative complications. Age 60 years and above (p-value, OR and 95%CI; 0.018,4.359 and 1.284-14.802), alcohol intake (p-value, OR and 95%CI; 0.042, 3.238 and 1.046-10.021) and resectional surgery (p-value, OR and 95% CI; 0.000, 1.20E and 938112920.94-1.54E+ 11) were the factors that showed statistical significance in determining post-operative mortality. Conclusion: Perforated peptic ulcer disease is emerging as a frequent cause of acute abdomen in our centre and affects the youth commonly. Age 60 years and above, duration of perforation for more than 24 hours before admission, alcohol intake and resectional surgery were the variables that showed statistical significance in predicting post-operative morbidity and/or mortality.

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

“…It is more common in males than females [17][18][19] . In our study, it was five times more common in males than females, and this is similar to findings in previous reviews 4,2 , but at variance with findings by Watt et al 20 . It appears to be a disease of the young and middle especially males, as our study suggests (93.3%).…”

“…Seven (15.6%) patients presented within 24hours from time of onset of symptom(s); this is low when compared with findings of 46.2% and 47.3% elsewhere 2,15,19 . Thirty seven (82.2%) patients had surgery on or before the 24 th hour on admission which is fair compared to a study in southwest Nigeria 14 but a far cry from better result by Bin-Taleeb et al 19 .…”

“…Consistent with findings elsewhere, fewer patients had dyspepsia prior to presentation compared to those who did not 14,15,25 . Use of ulcerogenic drugs like NSAIDS was low compared to the reports from Ghana 2,21 . This may be due to the younger age groups in our study: long term NSAID use is common in the elderly for care of osteoarthritis.…”

“…Also implicated in aetiopathogenesis is the use of NSAIDs in all the age groups 1,2,20,22,23 . Students formed the modal occupation group; it is still not clear if the was a chance finding, or what the risk factors in them were.…”

“…Gastro-duodenal perforations are common in surgical practice and do occur as a complication of peptic ulcer disease (PUD), abuse of non-steroidal anti-inflammatory drugs (NSAIDs) and gastric cancer [1][2][3][4][5][6] . Alcoholics and smokers are at higher risk 7,8 .…”