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

World Journal of Emergency Surgery

Japhet M Gilyoma²  Alphonce B Chandika²  Rodrick Kabangila¹  Hyasinta M Jaka¹  Mabula D Mchembe³  Mheta Koy¹  Joseph B Mabula²  Phillipo L Chalya² 

[1] Department of Internal Medicine, Weill-Bugando University College of Health Sciences, Mwanza, Tanzania;Department of Surgery, Weill-Bugando University College of Health Sciences, Mwanza, Tanzania;Department of Surgery, Muhimbili University of Health and Allied Sciences, Dar Es Salaam, Tanzania

关键词: Tanzania;    outcome;    surgical management;    clinical profile;    Perforated peptic ulcers;   

Others  :  792666
DOI  :  10.1186/1749-7922-6-31

 received in 2011-07-10, accepted in 2011-08-26,  发布年份 2011

【 摘 要 】

Background

Perforated 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.

Methods

This 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.

Results

A 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.

Conclusion

Perforation 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.

【 授权许可】

   
2011 Chalya et al; licensee BioMed Central Ltd.

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