Management of patients with perforated peptic ulcer disease at al-Gamhouria Teaching Hospital, Aden-Yemen, January 2003 to June 2006

Abstract EN

The objectives were to determine the frequency of perforated peptic ulcer disease , to study the clinical patterns, to find out the emergency surgical treatment performed and to evaluate the immediate postoperative complications .

Methods : This is a descriptive and prospective clinical study, involving all patients with diagnosis of perforated peptic ulcer disease ( PUD ) who were admitted to emergency surgical department at Al-Gamhouria Teaching Hospital , Aden –Yemen, during the period from January 2003 to June 2006 .

The studied variables included demographic data (age, sex ) , mode of clinical presentation , symptoms and physical signs , radiological investigations , operative diagnosis , post-operative complications, hospital stay and the general outcome for 3-6 months after discharge .

Results : The overall surgical incidence of perforated PUD in the hospital was about 1% of the total emergency admissions while it constituted 3.7 % of acute abdominal admissions .

The male to female ratio was 7 : 1 .

The mean age was 39.80 years with a range from 22 to 77 years and the peak incidence was observed in the age group (31–40) years.

It is found that half of the patients had history of dyspepsia and or history of PUD , 67.5 % were presented after 24 hours of the pain onset and 90 % of them had positive air under diaphragm by radiographic study.

Total postoperative morbidity was 37.5% and postoperative mortality was 2.5% .

The most common post-operative complication was wound infection 27.5% .

Conclusions and recommendations : This study found that surgical treatment by sealing of the perforation with omental patch , followed by medical anti-acid and anti-helicobacter pylori treatment was a safe emergency treatment with acceptable morbidity and lower mortality, as compared to what is reported worldwide .

It is recommended that perforated peptic ulcer have to be seriously differentiated in patients with acute peritonitis .

Patients must be operated on as early as possible.

Simple closure of perforation is safe in risky patients with delayed presentation and for junior surgeons .

It is recommended too , in our hospital , to study the feasibility of surgical treatment with concurrent definitive surgical therapy ( truncal vagotomy with drainage proceeder or gastric resection according to the type of peptic ulcer ) .