An Audit of Perforated Peptic Ulcer Disease in a Tropical Teaching Hospital.

Background: Perforated peptic ulcer (PPU) is associated with high morbidity and a mortality rate. Thus it requires urgent surgical intervention. Recently a reduction in the rate of peptic ulcer perforation in young men with a relative increase in the elderly and in women has been documented. This study is an audit of perforated peptic ulcer surgical emergencies treated by the gastrointestinal surgery division of a teaching hospital in Nigeria. It also reviews the early complications and the average duration of admission of these set of patients.
Method: This was a retrospective five-year audit of patients admitted by the gastrointestinal surgery division of a tertiary teaching hospital in Ibadan Nigeria. The data extracted from the patients’ records included the bio-demographical data, the duration of symptoms prior to admission, the patients’ vital signs at presentation and the results of the haematological investigations. Other information includes the duration from admission to surgery, the intra-operative findings and the outcome of the treatment.
Results: Forty patients consisting of thirty three male and seven female were treated. The ages ranged from 20 years to 70 years. The peak incidence was in the fifth decade. None of the patients was seen within 6 hours of the onset of symptoms however fifteen patients were seen within twenty four hours of the onset of symptoms. Twelve patients (30%) had history of significant ingestion of non-steroidal anti-inflammatory drugs, nine (22.5%) had a significant history of alcohol ingestion, while one (2.5%) had a recent history of fasting prior to the onset of symptoms. The distribution of the sites of perforation, revealed a pattern of 9(22.5%), 21(52.5%) and 10(25%) in the body of the stomach, pre-pyloric region and the first part of the duodenum respectively. There were six mortalities.
Conclusion: The outcome is excellent when prompt and adequate resuscitation and surgical repair of perforation are done. Health education may increase patient awareness which may translate to early presentation. Risk scores may be helpful in predicting the outcome but an experienced clinical opinion is still essential