MANAGEMENT OF PERFORATED DUODENAL ULCER IN A RICSOURCE POOR ENVIRONMENT

Abstract

Background: The majority of literature on the management c f perforated duodenal ulcer
comes from the west. However, this is not necessarily appropx iate in the developing world
where perforated ulcers occur in younger patients, there isa strc ngassociation withcigarette
smoking, and presentation is often delayed.
Objective: An attempt to guide management of perforated duoclenal ulcer in the developing
world using the best evidence available.
Data sources: Review of the literature on perforated ulcers and I etrospective chart review of
cases from a rural African hospital.
Study selection: Relevant studies from the western and developing world literature.
Data extraction: Med-line search.
Data synthesis: Assessment of relevance to clinical managemcmt of perforated duodenal
ulcers in the developing world.
Conclusions: Due to recognition of Heficobacterpylnri (HP) as a ,:ausative agent in duodenal
ulcer disease many western surgeons are questioning the need for definitive ulcer surgery in
the acute management of perforated duodenal ulceration. T11is philosophy may not be
appropriate in the developing world due to poor HP eradicatior rates, conditions fostering
re-infection with HP, problems with patient compliance in taking i nedications, and difficulties
with follow-up. It is suggested that selected patients, without pr1:operative risk factors, are
offered definitive surgery but those at any risk of postoperativc mortality be treated with
conservative surgery and treatment for HP. These patients will have to be followed closely
to check ulcer healing. Attention will also need to be paid to stol~ping smoking.