6-FACTORS AFFECTING MORBIDITY AND MORTALITY IN PERFORATED DUODENAL ULCER

Abstract

kassim Trayem Hayef* & Adnan Yassin Abdul-Wahab@ *MBChB, Al-Sader Teaching Hospital, Basrah. @MBChB, FRCS, Assist. Professor, Department of Surgery, College of Medicine, University of Basrah, Basrah, Iraq. Abstract Duodenal ulcer is a particular type of peptic ulcer disease that afflicts the lining of the duodenum. The indications for surgery in duodenal ulcers are; bleeding, perforation, obstruction and intractability or non-healing. Today, most patients undergoing operation for duodenal ulcer disease have simple over-sewing of bleeding ulcer or simple patch of perforated ulcer. Simultaneous performance of vagotomy either truncal or highly selective is increasingly uncommon because of reliance on postoperative proton-pump inhibitor to decrease acid secretion and eradication therapy for helicobacter pylori infection. Despite of the widespread use of gastric anti-secretary agents and eradication therapy, the incidence of perforated duodenal ulcer has changed little. This study aimed to assess the factors that lead to increase the rate of morbidity and mortality in patients with perforated duodenal ulcer in different age groups and to know the effect of time lapsed between onset of symptoms and surgery. This is a prospective study that included 100 patients who underwent emergency laparotomy for perforated duodenal ulcer during a period from May 2008 to January 2011. The operations were done in Al-Sader Teaching Hospital and Al-Basrah General Hospital. The clinical finding, general risk factors, co-morbid medical diseases, operative finding and post–operative complications were all taken in consideration. Follow-up period ranged from 2 weeks to 18 months. Of the hundred cases who included in this study, 96% were males and 4% were females with mean age of 43.13 years (range from 10 to more than 70 years). The disease was more common in rural areas (58%) than in urban areas (42%). Fifty five percent of patients gave previous history of duodenal ulcer and 45% had no previous history of duodenal ulcer. The most common risk factors are smoking (32%) and NSIADs (25%). In this study most of elderly patients presented with medical diseases such as hypertension, diabetes mellitus, ischemic heart disease and chronic obstructive pulmonary disease. Most patients admitted to hospital between 19–24 hours (21%), (8%) admitted during 6 hours and (2%) admitted after 120 hours. Regarding the complications occurs in this study, wound infections, chest infections and paralytic ileus were the most common complications. Mortality rate was 2%. In conclusion, the most common factor that leading to development of postoperative complications is delayed in hospital admission, so to improve the results of treatment of perforated duodenal ulcer, the diagnosis and treatment should not be delayed and the associated medical illness should be treated.

Keywords

• perforated
• duodenal
• ulcer