Perforated Peptic Ulcer in Rwanda: Epidemiology and Outcomes at a Tertiary Hospital in Kigali, Rwanda-A Retrospective Study

INTRODUCTION: Perforated peptic ulcer (PPU) is a serious complication of Peptic Ulcer Disease (PUD).
This study aims to present the experience of managing patients with PPU over a multi-year period at the University Teaching Hospital of Kigali (CHUK).
METHODS: A retrospective chart review was performed on all the charts of patients treated for PPU at CHUK from 2013-2017. Descriptive analysis, such as percentages and frequencies, were reported, and the relationship between variables was assessed using chi-square.
RESULTS: Over the 66 months, 142 patients were admitted to CHUK with PPU. 81% were male and 19% were female. The mean age was 40, with a range of 13 to 79 years. Abdominal distension (89%) and rebound tenderness and guarding (63%) were the most common presenting findings. The mean duration of symptoms was four days and most of the patients (70%) presented 24 hours after the onset of the symptoms. 96% of the patients had no associated comorbidities, and the pre-pyloric site (32%), was the most likely to perforate. Intraoperatively, inflammatory (turbid) fluid (42%), was the most common intra-abdominal fluid found. All patients underwent modified Graham’s repair. Sepsis (28%) and pneumonia (20%) were the most common post-operative complications. The mortality rate was 28%. The risk of mortality increased with the occurrence of any complication (p<0.001), and older age more than 61 (p=0.03).
CONCLUSION: Perforated peptic ulcers are not rare in Rwanda. PPU are associated with high morbidity and mortality. A system-based initiative aiming to improve the management of these patients is indicated.