Perforated peptic ulcer in south-eastern Nigeria 1973-1982

In a prospective study aimed at evaluating a safe treatment for tropical African conditions 205 patients who presented with perforation of a peptic ulcer in South Eastern Nigeria during the ten year period January 1973 to December 1982 were treated by simple suture. The ulcers were classified at operation from appearance as acute in 155 patients (75.6%), and chronic in the remaining 50 patients (24.4%). Of this number 21 patients (10.2%) died post-operatively. All 21 patients had chronic pyloroduodenal ulcers which were complicated by haemorrhage in 10 patients (5.0%) and extensive scarring of the duodenum and pyloric stenosis in 9 patients (4.4%). In contrast, no patient with acute pyloroduodenal ulcer died and none was known to suffer from recurrent dyspepsia at 6 months to 1 year follow-up. These results show that simple suture is an adequate and safe treatment for perforated acute pyloroduodenal ulcer but this treatment is, however, followed by an unacceptably high mortality in patients with perforated chronic pyloroduodenal ulcers in whom were feasible, a definitive ulcer--curative surgery should be performed.