THE PATTERN OF PEPTIC ULCER PEFORATION IN UNIVERSITY OF MEDICAL SCIENCES TEACHING HOSPITAL ONDO
Keywords:Ulcer, Perforation, Abdomen
BACKGROUND: There is current decline in the rate of elective surgery for peptic ulcer disease. This is however associated with a corresponding increase in the rate of surgery for perforated peptic ulcer. The sociodemographic data attributable to this include chronic use of non steroidal anti-inflammatory drugs, a rising incidence of Helicobacter Pylori infection and consumption of alcohol and smoking. Also the morbidity and mortality associated with peptic ulcer perforation seems to differ between the developing and developed world. The point of perforation also differ. Our study aims to determine these differences and also highlight the pattern of presentation in our environment.
METHOD: This is a prospective observational study in which 100 patients were recruited for the study from January 2017 to January 2021.These patients were managed for perforated peptic ulcer disease. Data analysis was by SPSS version 23 (IBM incorporated, Chicago, USA).
RESULTS: A hundred patients (90 males and 10 females, male to female ratio 9:1) were recruited, age range 20-70 years. The age group 31-40 were mostly affected constituting 54 (54%) of all patients.
Chronic NSAIDS (Non-steroidal anti-inflammatory drug) consumption was the commonest risk factor 100 (100%), previous history of ulcer 35 (35%), chronic alcohol intake 30 (30%) and 24(24%) were smokers. 98(98%) complained of abdominal pain before presentation while 2 (2%) did not volunteer a history of abdominal pain. Most of them 94 (94%) presented within 48hrs. 96 (96%) had pneumoperitoneum on X-ray of the abdomen at presentation. 59(59%) had anterior pre pyloric/gastric perforation, while 41 (41%) had anterior duodenal bulb perforation. Size of perforation was 15mm or less in 90(90%). Repair was first done by initial closure and then transposition of pedicled omentum using non absorbable silk/vicryl sutures. The duration of hospital stay was between 14-36 days, mean 18days. Major morbidities were seen in 10(10%) and follow up was for a year and no mortality or recurrence of perforation was recorded post operatively.
CONCLUSION: peptic ulcer perforation is commoner in males and occurs more in the younger age group. The addiction to NSAIDS (Non-steroidal anti-inflammatory drug) has become a very serious issue that needs to be discouraged. All the patients confessed to prolonged consumption of NSAIDS (Non-steroidal anti-inflammatory drug) at some point. Gastric perforation at the prepyloric/gastric areas was commoner than perforation at the first part of the duodenum. The use of intensive care facilities in indicated cases and the same operative technique ensured a zero mortality rate in our patients.