Publication:

Acute peptic perforation: clinical profile and our experience with operative outcome

Background Perforated peptic ulcer is a serious complication of peptic ulcers with potential risk of grave complications. This study was conducted to evaluate the clinical presentation, management and outcome of patients with peptic ulcer perforation in our setting and to identify predictors of outcome of these patients.

Methods This was a retrospective study of patients who were operated for perforated peptic ulcers at Sheth V.S. General Hospital, Ahmedabad, Gujarat, India during period of 2003 to 2005. Data were collected using a pretested and coded questionnaire and analyzed.

Results Out of 50 cases enrolled in the study, 2 were treated by drainage under local anesthesia among them one expired and another one was undergone definite surgery 2 days later, so 49 patients treated by operative line of management. Males (n = 40) out-numbered females (n = 10) by a ratio of 4:1. The highest number in age group was 41-50 years, which are 12 in number. 66% patients were labourers. 32% had past history of acid peptic disease. The use of non-steroidal anti-inflammatory drugs, alcohol and smoking was reported in 8%, 6% and 40% respectively, 14% having alcohol and tobacco consumption, 32% having no other history. 98% showing free gas and 2% doesn’t showing free gas on plain erect x ray abdomen in our study. Duodenal (n = 41) to Gastric (n = 8) perforation ratio were 5:1. Graham’s omental patch (Graham’s omentopexy) of the perforations was performed in 80% of cases. Complication and mortality rates were 36.7% and 2.04% respectively. In follow up n = 20 patients showing mild to moderate abdominal pain.

Conclusions Perforation of peptic ulcer remains a frequent clinical problem in our environment predominantly affecting 41-50 years group labourer males known to suffer from Peptic ulcer disease. Simple closure with omental patch followed by Helicobacter pylori eradication was effective with excellent results in majority of survivors despite patients’ late presentation in our center.