Short-Term Outcome of Perforated Peptic Ulcer; Relation with Estimated Time from the Onset of the Abdominal Pain to Surgical Intervention

Background and aim of the work: perforated peptic ulcer still remains as one of the most common surgical emergencies and the high incidence of postoperative complications necessitates the identification of the factors associated with this morbidity. The aim of this study is to evaluate the various perioperative factors in patients operated for PPU and how these factors may affect the operative outcome. Methodology: Between January 2011 and Novermber 2019, 68 patients who were operated emergently for PPU in our hospital were included in this study. Demographic and clinical data, surgical procedures, intraoperative findings, postoperative complications were collected and analyzed retrospectively. Results: The mean age was 46.75 ± 14.05 years. Out of 68 cases there were 49 (72%) male patients and 19 (28%) female patients. The mean operation time was 81.32±12.18 minutes. The mean hospital stay period was 8.5±2.2. Most of the cases (94%) presented without a warning of previous history of PUD, predominantly in older males. 50% of cases presented within first 24 hours and therefore favors the better outcome. The commonest sites of perforation encountered in our set up are the 1st part of duodenum (72%), followed by prepyloric region perforations (25%). The size of perforations in most of the cases ranged from 0.5 cm to 3cmwith only two cases with size more than 3cm and they are treated with simple Graham’s omental patch. Common complications encountered were abdominal collection (11.8%), followed by pleural effusion/pneumonia (10.2%) with a mortality rate of 7%. Half of the patients were discharged home within the first week after surgery. Comparing estimated time from the onset of the perforation symptoms to time of surgical intervention against the length of stays has shown that there was a statistically significant correlation. Conclusion: the earlier the presentation of PPU to the emergency department resulted in betteroutcome. Those patients with high risk of perforation need to be identifiedto be diagnosed and managed immediately as they reach the hospital.