ABSTRACT
Background: Perforated peptic ulcer is a serious complication of peptic ulcers. Emergency operations for perforated peptic ulcer are associated with a high incidence of postoperative complications
Objective: The objective of this study was to determine the effect of perioperative risk factors and co morbid diseases on postoperative morbidity in perforated peptic ulcer patients
Patients and Methods: This was a prospective study on 102 patients who were operated for perforated peptic ulcer in surgical ward of Bahawal Victoria Hospital, Bahawlpur, from 1[st] January, 2011 to 31[st] December, 2012. All patients of peptic ulcer perforation were included in this study. Perforations due to malignancy or marginal ulcers were excluded. Data was collected using a preformed questionnaire. Variables included in the questionnaire were; patient's demographic data [age, sex], duration of illness, previous history of Peptic Ulcer Disease, NSAID use, alcohol use and cigarette smoking, associated medical co morbid illness, preoperative shock status at admission, interval between ulcer perforation and operation, operating time, site of perforation, size of perforation, type of surgical procedure and postoperative complications. Data was analyzed using SPSS computer software version 16.0
Results: A total of 102 patients were included. Males to females ratio was 4.6:1]. The incidence of disease was high in age group of 31-40 years 30.4% followed by age group of 41-50 years 28.4%. Analysis showed that age above 60 years [P=0.02], the presence of preoperative shock [p=0.00], history of smoking [p=0.038], interval between perforation and operation [P=0.00], spillage more than 500 ml [p=0.00], type of operation [p=0.022], an operating time over 120 minutes [p=0.00] were significantly associated with postoperative morbidity. The most frequent underlying diseases were chronic cough [pulmonary disease] which was present in 15% patients, hypertension 10%, diabetes mellitus 10% and heart disease 10%
Conclusion: Age more than 60 years, the presence of preoperative shock, smoking, H/O NSAID intake, operation after 24 hours of perforation, operation time more than 2 hours, size of perforation and spillage more than 500ml were significant risk factors for morbidity from a perforated peptic ulcer
ABSTRACT
It is harvesting season of crop sowed in the last decade under the umbrella of Prime Minister Health Program as we are facing the complications of illegal abortions done by the health workers .It is to emphasize to the health workers and Health Program organizers to disengage from the practice objectives are to; estimate the frequency of its complications, discuss types of complications encountered with its mortality and morbidity and demonstrate the ways of its notification and prevention. All patients admitted with peritonitis due to illegal abortions were included in the study during one year period. Results showed alarming increase of illegal abortions complications [53% of total peritonitis cases] with most common injuries to colon or small bowel. Mortality was 6% and morbidity 94%. Conclusion were made that extensive technical and ethical training of health workers and surgeons are needed along with resurrection of regional ethical committee to look after the affairs