Perforated Duodenal Ulcer: A Review Of Fourteen Consecutive Patients
Context: Due to the dire nature of perforated peptic ulcer, fatality could occur if prompt surgical intervention is not employed. Poor prognostic factors include delay in presentation, co-morbid medical factors and preoperative shock.
Objective: To review patients of perforated peptic ulcer seen over a four-year period (2008 -2012); examining for outcomes and prognostic indices.
Methods: The available records of patients that had laparatomy for perforated peptic ulcer over the four year period at Central hospital Warri and Delta state university teaching hospital were accessed and relevant data of age, symptoms at presentation, duration of symptoms, intraoperative findings and outcome were studied.
Results: There ten male and four female patients. Their mean age of 39.9 (+15.7) years. The duration from the commencement of symptoms to surgical intervention ranged between 72 and 216 hours (three to nine
days), mean 5.1 (+1.9) days. No case was diagnosed within 48hours of occurrence. Epigastric pain, vomiting and abdominal swelling were commonest symptoms. Perforation occurred at the duodenum in ten patients while four patients had gastric perforation Chest X-ray available in five patients showed pneumoperitoneum in three patients. Omental patch closure was done in all the patients with an intrabdominal drain left in the
paracolic gutter or pelvis. Two of the patients (14.3%) developed residual intrabdominal abscesses. A singular case of omental repair leak was recorded. No incidence of reperforation was noted. Deaths occurred in four
patients (29%); three of the deaths occurring within 24 hours of intervention. The demised patients had diagnosis and intervention five days from the commencement of symptoms. Hypotension at presentation was a poor prognostic sign.
Conclusion: Presentation after 24 hours was not an adverse prognostic factor in our patients contrary to published literature. However, delay in presentation at 120 hours (five days) and preoperative hypotensionwere observed in the demised patients. The absence of a functional ventilator in the intervening centres, contributed to the mortality recorded in this series. We strongly implore that skilled anaesthesia be employed at surgery on these patients.
Key words: Perforation, duodenum, gastric, ulcer