Acute perforated peptic ulcer at El Obeid hospital, western Sudan

The pattern of peptic ulcer disease and its complications has changed during the last two to three decades. To state the frequency of acute peptic ulcer perforations and outcomes of their management at El Obeid Hospital, Western Sudan. This is an audit of patients with acute perforated peptic ulcer admitted to the emergency wards of the University Surgical Unit at El Obeid Teaching Hospital, Western Sudan during the period from January 2006 to December 2012. There were 53 patients, 94.3% were males. The age ranged between 18 and 77 years. Most of the patients reported late and 45.3% during Ramadan and Shawal. All patients had emergency peritoneal lavage and simple closure with omental patch followed by anti-ulcer therapy. The postoperative mortality was 7.6%. Perforated peptic ulcer in this community was mainly duodenal. Emergency peritoneal lavage and simple closure with omental patch followed by anti- ulcer therapy resulted in excellent outcomes. Old age, shock, peritonitis and septicaemia were the major risk factors for mortality

Appendicular mass at El Obeid Hospital, Western Sudan

Acute appendicitis is a common disease but some patients were only diagnosed after they develop serious complications like appendicular mass. The objective was to study the clinical presentations, treatment and outcomes of patients with appendicular mass seen at El Obeid Hospital, Western Sudan. In a prospective study the information about all patients with appendicular mass who were admitted to the wards of the University Surgical Unit at El Obeid Teaching Hospital, Western Sudan during the year 2012 were collected in a pre-designed questionnaire. The data were analyzed using SPSS PC packages version 17.5. There were one hundred and three patients; 58 males and 45 females. The mean age was 29.5 years [+/-] S.D. 17.8. Most of the patients [76%] came from rural areas. The delay in time of presentation varied from 3 days to two weeks, but the majority [93%] visited a clinical setting where misdiagnosed or mismanaged. 85% of the patients had appendicectomy [emergency or elective], 10% had drainage of appendicular abscess and 2% underwent right hemi-colectomy. 3% of the patients failed to re-appear for elective operation. Post-operative complications were fever [4.8%], wound infection [5.8%], paralytic ileus [1.9%] and faecal fistula [0.9%]. There was no mortality among this series. Most of the patients with appendicular mass were misdiagnosed or mismanaged before being admitted to the surgical wards. Awareness of the health providers in this community about acute appendicitis, its complications and its management needs to be revised

Acute appendicits: still a missed diagnosis in El Obeid, Western Sudan

One hundred and one patients with appendicitis were admitted to the emergency wards of the University Surgical Unit in El Obeid Teaching Hospital, Western Sudan during the period from July 2005 to June 2006. There were 64 males and 37 females. The mean age was 20.8 years +/- S.D. 12.8. 34 patients had appendicular mass, four patients had appendicular abscess and five patients had generalized peritonitis presenting with acute abdomen. Out of the 58 patients admitted as acute appendicitis, 15 patients were found to have perforated appendices at operation and the rest inflamed oedematous appendices, with a negative appendicectomy rate of zero per cent. These findings reflect the poor awareness about acute appendicitis and its seriousness in this area. It is the problem of late diagnosis rather than late presentation as all patients were misdiagnosed and put under treatment for other medical conditions before being admitted to the surgical wards