Pattern of Presentation and Treatment Outcome of Perforated Peptic Ulcer Disease patients, at Jimma University Medical Center, Jimma, Ethiopia.

Abstract

Background: Peptic ulcer perforation is one of the acute complications of peptic ulcer disease with significant morbidity and mortality. It occurs in 2-10% of patients with ulcer disease and its principal treatment is surgical. Objective: To describe pattern of presentation and treatment outcome of patients operated for perforated peptic ulcer disease from June 1, 2020 to May 30, 2022 at JUMC, Jimma, Ethiopia. Methodology: The study was retrospective descriptive cross sectional study. SPSS Version 26 used for analysis. The mean, standard deviation (SD), median and ranges were calculated for continuous variables and proportions and frequency tables were used to summarize categorical variables. Multivariate logistic regression was used for the significance of association between the independent and dependent variables in the categorical variables. Result: Totally, 73 patients were studied. Males were 91.8% with male to female ratio of 11.2:1. The age range is from 15 to 70 years and the peak age of incidence was at the 4th decade. Previous history of dyspepsia was the most common risk factor identified (57.5%). Over 78% of the patients presented after 24 hours of onset of symptoms. Abdominal pain, tenderness and guarding were present in all patients at presentation. Perforations were located on the anterior first part of the duodenum in 74%, making duodenal to gastric perforation 3:1. Size of diameter of the perforation ranges from 3-80mm and is 10 mm or less in 83.6% patients. Repair with omental pedicle flap (Cellan Jones) was done in 87.7% of patients. Post-operative complications were recorded in 33(45.2%) patients and hospital-acquired pneumonia was the commonest. Degree of peritoneal contamination was significantly associated with postoperative morbidity and mortality (P<0.05). Conclusion: In this study the overall morbidity and mortality is found to be high. Repair with omental pedicle flap (Cellan Jones) was the most common repair procedure. In this study degree of peritoneal contamination was significantly associated with postoperative morbidity and mortality. Recommendation: Prospective research has to be done to accurately assess known risk factors for PPUD. The hospital unit in charge of keeping records needs to pay attention to the alarmingly high number of lost patient charts caused by improper data handling. Awareness creation for nearby health facility staffs on the importance of early referral and health education for the community for early health care seeking behavior needs to be done.