Perforated gastric and duodenal ulcers in an urban African population

Perforations of the stomach and duodenum are frequent causes of acute generalized peritonitis in our environment. This is a prospective study of 331 cases of gastric and duodenal perforations.

A consecutive series of adult patients admitted and treated for acute generalized peritonitis due to peptic ulcer perforations was studied prospectively from January 1998 to June 2004. A specially designed proforma was used to record patient characteristics, clinical and operative findings and outcome. Additional information on self-medication and other relevant social habits was obtained and recorded. The data was analysed and the ratio of gastric to duodenal perforations as well as factors associated with perforations determined.

More males were affected by a ratio of 3.3:1. For all the patients the median age was 55.0 and the mean age was 52.2 +/- 17.5 years. The mean age of the perforated gastric ulcer patients was 47.7 +/- 17.1 years but higher for perforated duodenal ulcer patients at 64.8 +/- 11.4 years. There were 244 gastric and 87 duodenal perforations giving a ratio of 2.8:1. Most of these perforations were associated with the intake of Non Steroidal Anti Inflammatory Drugs (NSAIDS) 158 (47.7%), habitual ingestion of herbal medicines or concoctions 81 (24.5%) and prolonged fasting for religious reasons, 18 (5.4%). Acute renal failure 32 patients (31.1%), continuing or persistent peritonitis 12 patients (11.6%), wound infection 25 patients (24.3%), and chest infection 12 patients (11.6%), were some of the 103 post-operative complications seen. The overall mortality was 73( 22.1%). The death rate from perforated duodenal ulcer was 27 (32.2%) and that from perforated gastric ulcer was 46 (20.1%).

In our community perforated gastric ulcer is seen more often than perforated duodenal ulcer. These gastric perforations are related to the widespread use of NSAIDS and herbal medicines.