PRESENTATION AND MANAGEMENT OF PERFORATED PEPTIC ULCER DISEASE IN A TERTIARY CENTRE IN SOUTH SOUTH NIGERIA

Abstract

Background: Perforations of the stomach and duodenum are common complications of peptic ulcer disease (PUD), abuse of non steroidal anti inflammatory drugs (NSAIDS) and gastric cancer. Being a life threatening complication of PUD, it needs special attention with prompt resuscitation and appropriate surgical management if morbidity and mortality are to be avoided.

Aim: To determine the pattern and management outcome of perforated peptic ulcer disease PUD as seen in University of Port Harcourt Teaching Hospital (UPTH), Port Harcourt, Rivers State, Nigeria).

Methodology: All the patients with perforated PUD that were managed at UPTH between January 2006 and December 2014 were studied. Relevant data were extracted from the case notes and analysed using the Statistical Package for Social Sciences (SPSS) version 17.

Results: Thirty six patients with perforated PUD were evaluated consisting of 28 males and 8 females with a male to female ratio of 3.5:1. Their ages ranged from 24 to 65 years with a mean of 42.1± 12.3 years and the peak age was at the third decade. After adequate resuscitation, all the patients had exploratory laparotomy. In 26 (72.2%) patients, the perforation was in the duodenum while in 10 (27.8%), it was in the stomach. Thirty two (88.9%) patients had Graham's omental patch repair of the perforation while simple closure only was done in 4 (11.1%) patients. Surgical site infection was the commonest post operative complication which was seen in 7 (19.4%) patients while 4 patients died giving a mortality rate of 11.1%.

Conclusion: Perforated peptic ulcer predominantly affected young males and Graham's omental patch followed by Helicobacter pylori eradication was an effective treatment modality.

Keywords: Effective closure; Good outcome; Late presentation; Nigeria; Pattern; Perforated peptic ulcer disease; Port Harcourt.

Figure 1. Age and sex distribution