Seasonal Variation of Presentation of Perforated Peptic Ulcer Disease: An Overview of Patient Demographics, Management and Outcomes

Abstract

Background Perforated peptic ulcer disease (PUD) is one of the most common causes of acute peritonitis. It carries significant mortality and morbidity. Several previous studies have reported a seasonal variation in the presentation of patients with perforated ulcers. Here we present this study from our experience in a Northern Irish acute district hospital. Methods A retrospective cohort study was conducted on perforated peptic ulcer patients who presented to Altnagelvin Area Hospital emergency department between 2015 to 2020. Data on patient demographics, clinical presentation, investigations, management and outcomes were collected. Primary outcome was to investigate if seasonality was associated with the incidence of perforated peptic ulcers. Follow-up data were also collected. Seasons were defined as per UK Met Office. Results A total of 50 patients presented with perforated PUD. Male to female ratio was approximately 3:2. Peaks were noted in spring and winter. April was the most common month for presentation followed by December. Smoking was the most common risk factor followed by alcohol abuse. Fourteen patients (28%) were either very frail or had contained perforations and were conservatively managed. Three deaths were noted (6%). Thirteen patients (26%) required ICU admission at some stage in their management. Conclusion Slight seasonal variation was noted in the presentation of perforated peptic ulcers in our study with a higher incidence in the winter and spring months. The month of April was noted to have the peak incidence of the disease in our study.

Keywords: free air under the diaphragm; gastric perforation; intestinal perforation; perforated duodenal ulcer; perforated peptic ulcer.

Figure 1. Seasonal variation in incidence of perforated peptic ulcers.

Figure 2. Monthly variation in incidence of peptic ulcer perforations.

Figure 3. Erect CXR is better than AXR in the detection of the pneumoperitoneum (see white arrow).

CXR: chest X-ray; AXR: abdominal X-ray.

Figure 4. Small amount of subdiaphragmatic air suggesting bowel perforation (see white arrows).

Figure 5. CT coronal and sagittal reformat images showing the defect in the gastric wall (white arrow) and oedema of the gastric wall (blue arrows).

Figure 6. CT lung window helps to depict intra-abdominal air more than soft tissue window (see white arrows).