Pattern and outcome of perforated peptic ulcer disease patient in four teaching hospitals in Addis Ababa, Ethiopia: a prospective cohort multicenter study

Abstract

Background: Perforated peptic ulcer disease is a surgical emergency with a high morbidity and mortality. The socio-demographic characteristic and the factors associated with morbidity and mortality seems to differ between the developed and developing world. This is the first a prospective cohort study in Ethiopia designed to analyze pattern and outcome of patients with perforated peptic ulcer disease in four teaching hospitals affiliated with SOM, CHS of Addis Ababa University. Method: This is a prospective cohort study of patients operated for perforated peptic ulcer disease from June 1, 2018 to May 31, 2019 in four teaching hospital affiliated to department of surgery of SOM, CHS of Addis Ababa university. Result: A total of 97 patients were operated in a year. 86.6% were males with a male to female ratio of 6.5:1. The age group 21-30 were most affected constituting 42.3% of all patients. Mean age is 31.9, Median of 27, age ranges from 16 to 76. Alcohol use (45.4%) and previous history of ulcer disease (75.3%) were the most prevalent risk factors.33% were smokers. Abdominal was present in all and most presented within 48 h (79.4%). 85.6% had pneumo = peritoneum in an x-ray at presentation. Size of the perforation is 10 mm or less in 81.3%. 91(93.8%) had anterior first part duodenum perforation. Repair with pedicled omental patch was done in 65 (67.1%) patients. Age, duration of presentation, hypotension at presentation, size of perforation, degree of peritoneal contamination were found to be the significant factors for morbidity and mortality. Major morbidities were observed in 16 (16.5%) and mortality occurred in 3 (3.1%) patients. Conclusion: Perforation of peptic ulcer disease here occurs in the young. Age, duration of presentation, hypotension at presentation, size of perforation, degree of peritoneal contamination were found to be the significant factors for morbidity and mortality. Morbidity and mortality rate of 16.5 and 3.1% observed here are quite acceptable.

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

“…Positive previous history of peptic dyspepsia was observed in nearly half (25 (49%)) of the patients with peptic ulcer, this might explain the inaccessibility of good health facilities, and most of them may encounter non-professional health workers and traditional healers in many parts of the regions, and patient will seek proper health care facility when condition gets worse and patient develops severe abdominal pain and peritonism. This finding is common in developing countries as several reports stated [ 8 , 10 , 13 ].…”

The global, regional and national burden of peptic ulcer disease from 1990 to 2019: a population-based study

“…NSAIDs use rates in these areas were significantly lower than those in developed countries [35,36]. Studies have also shown that the rates of severe PUD-related complications, such as perforation of the digestive tract, are high in these countries and territories and appear to be associated with Khat intake [37]. When stratified by SDI, the incidence of PUD showed decreasing trends in different groups over time.…”

Outcome Prospective of Late Duodenal Perforation Repairs in Elderly

“…All the patients in our study generally describe a sudden and severe epigastric pain on admission, this pain being localized early on and then spreading rapidly to the abdomen 19 . In a study by Lau et al; showed that patients usually present with severe, sudden upper abdominal pain that is localized initially and then spreading rapidly [20][21] In this study, death occurred in 13 patients which was quite an acceptable mortality rate compared to other literature data 22 . Most of the patients died in the first week after surgery, on average after 4 days.…”