Abstract

A STUDY OF DUODENAL ULCER PERFORATION PROGNOSIS 2019

*Dr. Ali Hameed Atash and Dr. Ali Budr Abood

ABSTRACT

Background and Objectives: Duodenal ulcer perforation is one of the acute abdominal emergencies in the surgical field. Duodenal ulcers are often caused due to imbalance between mucosal defences and acid /peptic injury. the cases of duodenal ulcer perforation in surgically treated patients were thoroughly studied with respect to trends in age, distribution of occurance, risk factors, seasonal variation, outcome of operative and non-operative modalities of treatment and factors influencing the prognosis of the disease. The current study summarizes epidemiology, risk factors, Pathophysiology, pathogenesis, clinical features, investigations, modalities of treatment and prognostic determinents of duodenal ulcer perforation in department of surgery, Iraq. Material and Methods: The study was conducted in the Department of surgery,. Teaching and General Hospital, .during the period of Nov. 2016 - Sep. 2019. The diagnosis of duodenal ulcer perforation was that established by the admitting surgeon, based on clinical features and supposed by radiological evidence and confirm at operation. Surgery was defined as urgent less as 4 hours between admission and surgery, same day (4-24 hours) and delayed at a later time during the same admission. This study comprises of 30 cases of duodenal ulcer perforation admitted in the Department of surgery,. Teaching & General Hospital. Operative details included the site and nature of operation performed. Mortality was defined as death following surgical procedure. Post-operative morbidity was defined in terms of duration of hospital stay and associated complications following surgery. Inclusion Criteria: All patients in whom a diagnosis of duodenal ulcer perforation was established on admission and confirmed by investigations between November 2016-September 2019 are included in this study. Exclusion Criteria: 1. Cases of gastric antral perforation. 2. Cases of traumatic duodenal perforation. Results: out of 30 cases, the peak age incidence was between 40 and 49 years, only 3 cases of females with perforated duodenal ulcers were observed, 39 cases (65%) belonged to lower socio-economic status, 57 males were either indulged with smoking (40%) or alcohol (30%) or both (25%), 36 patients (30%) had previous history of peptic ulceration, NSAIDs intake was associated with 26.67%, study the maximum incidence of perforation was during the four month of the winter 33 (66%), 55 patients (91.67%) had pneumo-peritoneum, 13 patients had wound infection and 7 out of them were expired. Conclusion: A series of sixty cases duodenal perforations were studied and analyzed at Department of surgery,. Teaching and General Hospital,. during the period of Nov 2016-Sep. 2019. The following is the list of the conclusions drawn after the study: 1. Duodenal ulcer perforation is one of the most common acute abdominal emergencies. 2. Duodenal ulcer perforation was more common in the age group of 40-49 years. 3. In this study the male: female ratio was found to be19:1. 4. Duodenal peroration was common in lower socioeconomic group. 5. The associated risk factors are found to be smoking, alcohol intake, NSAIDs intake and previous history of acid peptic disease. 6. Duodenal perforation cases were high during winter season. 7. Symptoms like abdominal pain and diarrhea were present in all patients with DU perforation. 8. Signs of G/R and BS were common in patients with DU perforation. 9. Wound infection was common post-operative complications. 10. Mortality rate was higher in case of geriatric patients with comorbid illness. 11. Mortality rate in the age group of above 30 years is as high as 44.44%. 12. Prognostic factors were, a. Age, b. Comorbid illness, c. Duration of symptoms, d. Delay in taking up the patient for emergency operation, e. Patient’s general condition at the time of presentation.

Keywords: Duodenal Ulcer Perforations, H. Pylari Prospective, Simple Closure with Omental Patch Prognostic Factors.