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Pattern of Presentation, Management and Early Outcome in Patients with Perforated Peptic Ulcer Disease in a
Olaogun Julius Gbenga1, Dada Samuel Ayokunle2, Akanbi Ganiyu3
1Department of Surgery, Ekiti State University, Ado-Ekiti, Ekiti State, Nigeria.
Insights
Perforated peptic ulcer disease (PUD) leads to high mortality, often linked to NSAID and herbal concoction abuse. Early presentation and management are crucial for reducing complications and deaths in PUD patients.
Area of Science:
- Gastroenterology
- Surgical Gastroenterology
- Public Health
Background:
- Perforated peptic ulcer disease (PUD) is a critical surgical emergency with significant morbidity and mortality.
- It represents the most frequent reason for emergent surgery in PUD patients.
Purpose of the Study:
- To investigate the clinical presentation patterns.
- To analyze the management strategies.
- To evaluate the early outcomes of perforated PUD patients.
Main Methods:
- A prospective study was conducted over five years (June 2015 - May 2020).
- Patients undergoing surgery for perforated PUD at Ekiti State University Teaching Hospital (EKSUTH) were included.
- Data on demographics, symptoms, risk factors, surgical procedures, and outcomes were collected.
Main Results:
- 46 patients (21-85 years) were studied; males predominated (5.5:1 ratio).
- Common risk factors included NSAID use (54.3%) and herbal concoctions (52.2%). Duodenal perforations were most frequent (63.0%).
- Postoperative complications occurred in 34.8%, with wound infection being most common. Mortality was 17.4%, associated with advanced age, comorbidities, delayed presentation, shock, and large intraperitoneal fluid volume.
Conclusions:
- Perforated PUD contributes significantly to morbidity and mortality in the studied region.
- NSAID and herbal concoction abuse are identified as primary risk factors.
- Public health interventions to control the sale of NSAIDs and herbal concoctions are recommended to mitigate this health issue.
Background:
Perforated peptic ulcer is a life-threatening complication with a high morbidity and mortality. It is the most common indication for emergency operation in peptic ulcer disease (PUD) patients. This study aimed to describe the pattern of presentation, management and early outcome in patients with perforated PUD.
Methods:
This was a prospective study of patients who had operation for perforated PUD at Ekiti State University Teaching Hospital (EKSUTH), Ado-Ekiti, Southwestern Nigeria from June 2015 to May 2020.
Results:
Forty-six patients were studied with their ages ranging from 21-85 years. Their mean age was 49.9±16.3 years while the median was 54 years. Males outnumbered females by a ratio of 5.5:1. Majority (56.5%) of the patients were farmers and artisans. Duration of symptoms was 6 hours to 9 days (mean 2.7±1.9 days). Non-steroidal anti-inflammatory drugs use, herbal concoction, alcohol and smoking was found in 54.3%, 52.2%, 30.4% and 21.7% respectively. More duodenal perforations (63.0%) were recorded. Graham's patch closure was done for 27 (58.7%) while the remaining (41.3%) had primary closure with omentoplasty. Sixteen (34.8%) had postoperative complications with wound infection predominating. Overall postoperative mortality was 17.4%. Age ≥ 60 years (p=0.04), premorbid illness (p=0.01), delayed presentation ≥ 48 hours (p=0.01), shock (p=0.01) and intraperitoneal effluent ≥ 2000ml (p=0.03) were associated with mortalities.
Conclusion:
Perforated PUD accounts for high morbidities and mortalities in our setting. Abuse of NSAIDs and herbal concoction ranked highest among the risk factors. Efforts at curtailing indiscriminate sales of NSAIDs and herbal concoction will reduce the menace.
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