Background
Perforation is a life threatening complication of peptic ulcer disease which requires emergency admission and almost always urgent surgical intervention. It is associated with 30% mortality and 50% morbidity. The aim of this study is to assess treatment outcome of perforated peptic ulcers and its associated factors among surgically managed patients.
Materials and methods
A 5 year, tertiary hospital-based, retrospective cross-sectional study was conducted on treatment outcome and associated factors among 106 patients operated for perforated peptic ulcers from 2015 to 2020. Omental patch, wedge excision and repair, and total gastrectomy were done by residents and/or consultants in 94, 11, and 1 patient respectively. Treatment outcome was considered favorable if the patient discharged improved and unfavorable if the patient developed complications/died. Logistic regression analysis was conducted to identify associated factors.
Result
Out of 106 patients studied male to female ratio was 9:1. The mean age of patients was 36.13 ± 15.6years. Seventy-five (70.8%) patients presented after 24h of onset of symptoms. Most perforations were located on the first part of duodenum in 86 (81.1%) patients. Postoperative complications were identified in 30(28.3%) patients. Being female, delayed presentation, hypotension, and perforation site were significantly associated with postoperative morbidity (P < 0.05). Fifteen (14.2%) patients died in the hospital. Mortality was significantly associated with intra-operative level of contamination and development of post-operative complications (P < 0.05).
Conclusion
postoperative morbidity and mortality were significantly associated with delayed presentation and postoperative complications.
Highlights
Introduction and importance
Anal stenosis is narrowing of anal canal that may result from true anatomic stricture or functional stenosis. Anal stenosis from irritant chemical application for hemorrhoid is rare and tends to be more severe. There is scarcity of data in the literature regarding anal stenosis secondary to traditional medicine application for the treatment of hemorrhoid. This case report can create awareness to promote health education and health advancement, especially in areas with wide spread use of traditional medicine. In addition, it can motivate general surgeons to prepare themselves to handle such cases in the absence of colorectal surgeons.
Presentation of the case
A 75 years old male farmer presented with worsening of difficulty of passing feces and flatus and intermittent abdominal distention of 3 months. The patient has history of application of irritant chemical by traditional healer for treatment of hemorrhoid. Physical examination led to diagnosis of severe anal stenosis. Bilateral house advancement flap anoplasty done by a general surgeon with excellent result.
Discussion
The commonest cause of anal stenosis is hemorrhoidectomy. Other causes include other anorectal surgeries, anorectal diseases, and radiotherapy. Diagnosis of anal stenosis is by physical examination. Treatment is conservative for mild cases and advancement flap anoplasty for moderate to severe cases.
Conclusion
Health education and health advancement can create awareness, hence preventing people from having wrong treatments. House advancement flap anoplasty is a good option for the treatment of anal stenosis in resource limited setup, as it is easy to do and has good outcome.
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