Perforated Peptic Ulcer Disease at Kenyatta National Hospital; Nairobi

Background: Published reports on perforated peptic ulcers indicate increasing rates for the elderly; those chronically ill and females. Our local observations are at variance. This study analysed patients treated for peptic ulcer perforations at the Kenyatta National Hospital between January 2005 and December 2006. Methods: Clinical charts for patients admitted and treated for perforated peptic ulcer disease were reviewed. Data sought included patient demographic data; clinical presentation; and time from onset of symptoms to treatment; operative findings and treatment mplications. The determinants of post-operative complications were evaluated using univariate analysis. Results: Forty four patients with perforated ulcers were admitted and treated over a two year study period. Twenty eight were analyzed (retrieval rate 63.6). Males (86.2) and those 35 years of age and younger (57.1) predominated. Alcohol; smoking and prior use of non steroidal anti inflammatory drugs were respectively documented in 39.3; 39.3and 10.7of patients. The complication rate was 25. Four patients died. The factors significantly related to complications was treatment delay (p=0.007) and acute perforation (0.027) Conclusion: Perforated peptic ulcer disease is a disease of young males. Efforts to reduce delay in presentation in this population may reduce the complications

Experience with Acute Perforated Duodenal Ulcer in a West African Population

Background: The advent of proton pump inhibitors and helicobacter pylori eradication in the management of chronic peptic ulcer disease has reduced the operative treatment of this condition to its complications. Perforated duodenal ulcer remains a major life threatening complication of chronic peptic ulcer disease. This retrospective study reviews our experience at the Royal Victoria Teaching Hospital . Methods: All patients with clinical diagnosis of perforated duodenal ulcer seen in this hospital between June 2003 and October 2005 were included in this study. Data extracted from their hospital records were analyzed for age; sex; duration of symptoms; previous history of peptic ulcer disease; use of NSAIDS; main presenting features; investigations; resuscitative measures; time of surgery; operative findings; and type of surgery offered; complications and mortality. After resuscitation; laparotomy followed by simple closure or definitive ulcer surgery and helicobacter pylori eradication therapy was given to all the patients. Duration of follow up ranged 8 to 12 months with endoscopy in some patients. Results: There were 41 patients with intraoperative diagnosis of acute perforated duodenal ulcer seen over the study period; comprising 34 males (82.9) and 7 females (17.1); a male female ratio of 4.8:1; age range of 18-77 years and a mean age of 45.49+/-14.46 years. Previous history of peptic ulcer disease was found in 32 (78.6) of the patient and the main presenting features were sudden onset of severe abdominal pain in 95.1of cases and fever in 65.8. Features of frank peritonitis were demonstrable in all the patients and 11(26.8) presented in shock. Plain chest x-rays demonstrated gas under the diaphragm in 21(65.6) of the patients. After adequate resuscitation; all the patients underwent laparotomy where the abdomen was explored; the diagnosis of perforated duodenal ulcer was confirmed and 29(70.7) had simple closure of the perforation with omentum (after Graham). The average time between presentation and surgery was 9 hours (range 6-11hours). The mean size of perforation was 10.5mm (range 5- 15mm). Definitive peptic ulcer surgery was done in 12 (29.3) patients. 8 had truncal vagotomy and pyloroplasty. The major complications included wound infection in 14 (34.1); postoperative fever in 16 (39.0) and prolonged ileus in 15 (36.6) There were 7 deaths; mortality rate of 17.1and the causes of death included severe electrolyte imbalance in 1 and gram negative septicaemia and shock in 6. The average duration of hospital stay was 10 days (range 8 36). Conclusion: Perforated duodenal ulcer is a major complication of chronic peptic ulcer disease. Simple omental patch by open method and helicobacter pylori eradication therapy is sufficient to prevent reperforation

Ulcere de stress perfore et syndrome de Lyell. A propos d'une observation

La perforation d'un ulcere gastrique liee au stress est rare. Nous en rapportons un cas compliquant un syndrome de Lyell chez un homme de 35 ans; sous anti-tuberculeux depuis 12 jours. Trois jours apres son admission en soins intensifs apparaissait insidieusement un tableau de peritonite aigue generalisee avec une image de pneumoperitoine a la radiographie de l'abdomen sans preparation. Une laparotomie exploratrice etait indiquee decouvrant une perforation gastrique sur la face anterieure de la petite courbure; perforation qui avait ete suturee. Une detersion des lesions cutanees etait par la suite effectuee suivi de pansement gras occlusif. En post-operatoire immediat; le deces survenait rapidement dans un contexte de choc septique. Les aspects de la prise en charge de cette association pathologique particuliere sont discutes