Clinical profile and outcome of surgical treatment of perforated peptic ulcers in Northwestern Tanzania: A tertiary hospital experience

Abstract

BackgroundPerforated peptic ulcer is a serious complication of peptic ulcers with potential risk of grave complications. There is paucity of published reports on perforated peptic ulcer disease in our local environment. This study was conducted to evaluate the clinical presentation, management and outcome of patients with peptic ulcer perforation in our setting and to identify predictors of outcome of these patients.MethodsThis was a combined retrospective and prospective study of patients who were operated for perforated peptic ulcers at Bugando Medical Centre between April 2006 and March 2011. Data were collected using a pre-tested and coded questionnaire and analyzed using SPSS computer software version 15.0. Ethical approval to conduct the study was obtained from relevant authority before the commencement of the study.ResultsA total of 84 patients were studied. Males outnumbered females by a ratio of 1.3: 1. Their median age was 28 years and the modal age group was 21-30 years. The median duration of illness was 5.8 days. The majority of patients (69.0%) had no previous history of treatment for peptic ulcer disease. The use of non-steroidal anti-inflammatory drugs, alcohol and smoking was reported in 10.7%, 85.7% and 64.3% respectively. Eight (9.5%) patients were HIV positive with a median CD4 count of 220 cells/μl. Most perforations were located on the duodenum {90.4%) with the duodenal to gastric ulcers ratio of 12.7: 1. Graham's omental patch (Graham's omentopexy) of the perforations was performed in 83.3% of cases. Complication and mortality rates were 29.8% and 10.7% respectively. The factors significantly related to complications were premorbid illness, HIV status, CD 4 count < 200 cells/μl, treatment delay and acute perforation (P < 0.001). Mortality rate was high in patients who had age ≥ 40 years, delayed presentation (>24 hrs), shock at admission (systolic BP < 90 mmHg), HIV positivity, low CD4 count (<200 cells/μl), gastric ulcers, concomitant diseases and presence of complications (P < 0.001). The median overall length of hospital stay was 14 days. Excellent results using Visick's grading system were obtained in 82.6% of surviving patients.ConclusionPerforation of peptic ulcer remains a frequent clinical problem in our environment predominantly affecting young males not known to suffer from PUD. Simple closure with omental patch followed by Helicobacter pylori eradication was effective with excellent results in majority of survivors despite patients' late presentation in our center.

Epidemiology and Management of Perforated Peptic Ulcer: A Hospital Experience

“…This is comparable to a study in Kenya which reported a duodenal to gastric ulcer ratio of 11.5:1. 6 A high duodenal to gastric ulcer ratio of 25:1 was reported in Sudan. A study in Ghana reported high incidence of gastric ulcer perforations than duodenal ulcer perforation.…”

“…In case of perforated PUD ulcer, free intraperitoneal gas is less likely to be seen if the time interval between the perforation and radiological examination in short. 6 Recently, Computerized tomography (CT) scans with oral contrast are now considered the reliable method of detecting small pneumoperitonium before surgery and the gold standard for the diagnosis of a perforation. 6 Abdominal ultrasonography has also been found to be superior to plan radiographs in the diagnosis of free intra-peritoneal air.…”

“…6 Recently, Computerized tomography (CT) scans with oral contrast are now considered the reliable method of detecting small pneumoperitonium before surgery and the gold standard for the diagnosis of a perforation. 6 Abdominal ultrasonography has also been found to be superior to plan radiographs in the diagnosis of free intra-peritoneal air. None of these imaging studies were used in the diagnosis of free intra-peritoneal air in our study.…”

Clinical study and management of peritonitis secondary to perforated peptic ulcer

“…This study is similar to other studies in developing countries but differ from the demographic profile from developed countries where majority of the patient are above 60 years of age. 20 In this study only 26.6% patients had a history of ingested NSAIDs. The high incidence of perforated peptic ulcer occur in male in our study may be due to smoking and excessive alcohol consumption.…”

Graham Patch Versus Modified Graham Patch in the Management of Perforated Duodenal Ulcer

“…Overall complications rate in their series were higher than our series. This difference in complication can be explained by differences in antibiotic coverage, meticulous preoperative care and proper resuscitation of the patients before operation, improved 20 anaesthesia and somewhat better hospital environment .…”