GASTRO-DUODENAL PEPTIC ULCER PERFORATION

Abstract

Objectives: To determine the epidemiology of, and define the morbidity and mortalityfactors following emergency surgery for patients with perforated peptic ulcer diseasein Accra, Ghana.

Design: A retrospective and prospective hospital-based study.

Setting: The general and paediatric surgical wards of the Korle-Bu TeachingHospital.

Main outcome measures: Demography, the systolic BP, pulse rate and haemoglobinon admission at ER, co-morbid conditions, site of perforation, surgical method andtreatment outcome.

Subjects: A total of 326 cases treated for peptic ulcer perforation, 267 males and 59 females;ratio 4.5:1, with mean age of 40.9, SD 16.4 and range 4-87 years, were studied.

Results: The incidence of peptic ulcer perforation rose from 1.6% in 1998 to 5.3% in2002 and stabilised at 5%, and overall accounted for 4.6% of acute abdomen. Co-morbidconditions were present in 48 (18.2%) of cases. Ulcerogenic substance intake was in177 (67%) patients. One hundred and twenty two (46.2%) patients reported to hospitalwithin 24 hours of perforation. There were 287 (88%) duodenal, 22 (7.1%) prepyloric,and 19(4.9%) type 1 gastric ulcer perforations. Simple closure with omental patch wasperformed in 299(94.3%), truncal vagotomy and drainage in 10 (3.2%), and Billroth IIpartial gastrectomy in seven (2.2%). Post-operative complications occurred in 62 (19%);overall mortality was 36 (11%). Logistic regression analysis of the patients clinicalvariables showed that age less that 60 years (p-value, OR and 95% CI; 0.002, 3.964 and1 .668-9.420), duration of perforation of more than 24 hours before admission (p-value,OR and 95%CI; 0.011,2.471 and 1.228-4.971), alcohol intake (p-value, OR and 95%CI;0.009, 2.543 and 1.259-5.135) and resectional surgery (p-value, OR and 95%CI; 0.000,8.25E and 74204908.138-9162648048.1) were statistically significant in determining postoperativecomplications. Age 60 years and above (p-value, OR and 95%CI; 0.018,4.359and 1.284-14.802), alcohol intake (p-value, OR and 95%CI; 0.042, 3.238 and 1.046- 10.021)and resectional surgery (p-value, OR and 95% CI; 0.000, 1.20E and 938112920.94- 1.54E+11) were the factors that showed statistical significance in determining post-operativemortality.

Conclusion: Perforated peptic ulcer disease is emerging as a frequent cause of acuteabdomen in our centre and affects the youth commonly. Age 60 years and above,duration of perforation for more than 24 hours before admission, alcohol intake andresectional surgery were the variables that showed statistical significance in predictingpost-operative morbidity and/or mortality.