Surgical outcomes for perforated peptic ulcer: A prospective case series at an academic hospital in Monrovia, Liberia
The incidence of perforated peptic ulcer remains high in low and middle-income countries. Mortality can be significant, and early surgical management with careful evaluation of pre-operative risk factors is essential. The purpose of this study was to describe the clinical outcomes of surgical treatm...
| Main Authors: | , , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Elsevier
2015-06-01
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| Series: | African Journal of Emergency Medicine |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2211419X14001384 |
| _version_ | 1811323898543734784 |
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| author | J. Fallah Moses Christopher D. Hughes Pratik B. Patel Tiffany E. Chao Solomane A. Konneh Torsou Y. Jallabah Michael Kiiza Kikubaire John G. Meara Lars E. Hagander |
| author_facet | J. Fallah Moses Christopher D. Hughes Pratik B. Patel Tiffany E. Chao Solomane A. Konneh Torsou Y. Jallabah Michael Kiiza Kikubaire John G. Meara Lars E. Hagander |
| author_sort | J. Fallah Moses |
| collection | DOAJ |
| description | The incidence of perforated peptic ulcer remains high in low and middle-income countries. Mortality can be significant, and early surgical management with careful evaluation of pre-operative risk factors is essential. The purpose of this study was to describe the clinical outcomes of surgical treatment for perforated peptic ulcer disease in Liberia and to explore risk factors for adverse outcomes.
Methods: This study prospectively examined 20 consecutive patients undergoing primary closure with omental patch for perforated pre-pyloric or duodenal peptic ulcer at the John F. Kennedy Medical Centre (JFKMC) in Monrovia, Liberia from May 2009 to March 2010. Pre-operative information was captured in a questionnaire. Risk factors were assessed for univariate and multivariate associations with in-hospital mortality.
Results: Median age was 33 years and 85% were males. A majority of the patients (70%) had a history of gastritis and antacid use. Median time from beginning of symptoms to surgery was 4.5 days. Over-all in-hospital mortality following surgical therapy for perforated peptic ulcer disease was 35%. Median length of stay among survivors was 16 days, and death occurred at median 1 day after admission. Long symptom duration and age >30 years of age were significantly associated with in-hospital mortality on univariate (β = 2.60 [0.18–5.03], p = 0.035) and multivariate testing (β = 2.95 [0.02–5.88], p = 0.049).
Conclusion: Peptic ulcer disease and its treatment represent a potentially substantial source of morbidity and mortality in limited-resource settings. In this case series, surgical treatment for perforated peptic ulcer disease carried a high mortality, and the results highlight the potential for public health systems strengthening to prevent poor health outcomes. Peptic ulcer disease in low- and middle-income countries presents unique epidemiology and treatment challenges that may differ significantly from evidence-based guidelines in high-income countries. |
| first_indexed | 2024-04-13T14:03:38Z |
| format | Article |
| id | doaj.art-cca8782c359a491aa692ebc2469b3556 |
| institution | Directory Open Access Journal |
| issn | 2211-419X |
| language | English |
| last_indexed | 2024-04-13T14:03:38Z |
| publishDate | 2015-06-01 |
| publisher | Elsevier |
| record_format | Article |
| series | African Journal of Emergency Medicine |
| spelling | doaj.art-cca8782c359a491aa692ebc2469b35562022-12-22T02:43:58ZengElsevierAfrican Journal of Emergency Medicine2211-419X2015-06-0152606510.1016/j.afjem.2014.11.002Surgical outcomes for perforated peptic ulcer: A prospective case series at an academic hospital in Monrovia, LiberiaJ. Fallah Moses0Christopher D. Hughes1Pratik B. Patel2Tiffany E. Chao3Solomane A. Konneh4Torsou Y. Jallabah5Michael Kiiza Kikubaire6John G. Meara7Lars E. Hagander8John F. Kennedy Medical Center (JFKMC), Monrovia, LiberiaProgram in Global Surgery and Social Change, Harvard Medical School, Boston, MA, USAProgram in Global Surgery and Social Change, Harvard Medical School, Boston, MA, USAProgram in Global Surgery and Social Change, Harvard Medical School, Boston, MA, USAJohn F. Kennedy Medical Center (JFKMC), Monrovia, LiberiaJohn F. Kennedy Medical Center (JFKMC), Monrovia, LiberiaJohn F. Kennedy Medical Center (JFKMC), Monrovia, LiberiaProgram in Global Surgery and Social Change, Harvard Medical School, Boston, MA, USAProgram in Global Surgery and Social Change, Harvard Medical School, Boston, MA, USAThe incidence of perforated peptic ulcer remains high in low and middle-income countries. Mortality can be significant, and early surgical management with careful evaluation of pre-operative risk factors is essential. The purpose of this study was to describe the clinical outcomes of surgical treatment for perforated peptic ulcer disease in Liberia and to explore risk factors for adverse outcomes. Methods: This study prospectively examined 20 consecutive patients undergoing primary closure with omental patch for perforated pre-pyloric or duodenal peptic ulcer at the John F. Kennedy Medical Centre (JFKMC) in Monrovia, Liberia from May 2009 to March 2010. Pre-operative information was captured in a questionnaire. Risk factors were assessed for univariate and multivariate associations with in-hospital mortality. Results: Median age was 33 years and 85% were males. A majority of the patients (70%) had a history of gastritis and antacid use. Median time from beginning of symptoms to surgery was 4.5 days. Over-all in-hospital mortality following surgical therapy for perforated peptic ulcer disease was 35%. Median length of stay among survivors was 16 days, and death occurred at median 1 day after admission. Long symptom duration and age >30 years of age were significantly associated with in-hospital mortality on univariate (β = 2.60 [0.18–5.03], p = 0.035) and multivariate testing (β = 2.95 [0.02–5.88], p = 0.049). Conclusion: Peptic ulcer disease and its treatment represent a potentially substantial source of morbidity and mortality in limited-resource settings. In this case series, surgical treatment for perforated peptic ulcer disease carried a high mortality, and the results highlight the potential for public health systems strengthening to prevent poor health outcomes. Peptic ulcer disease in low- and middle-income countries presents unique epidemiology and treatment challenges that may differ significantly from evidence-based guidelines in high-income countries.http://www.sciencedirect.com/science/article/pii/S2211419X14001384 |
| spellingShingle | J. Fallah Moses Christopher D. Hughes Pratik B. Patel Tiffany E. Chao Solomane A. Konneh Torsou Y. Jallabah Michael Kiiza Kikubaire John G. Meara Lars E. Hagander Surgical outcomes for perforated peptic ulcer: A prospective case series at an academic hospital in Monrovia, Liberia African Journal of Emergency Medicine |
| title | Surgical outcomes for perforated peptic ulcer: A prospective case series at an academic hospital in Monrovia, Liberia |
| title_full | Surgical outcomes for perforated peptic ulcer: A prospective case series at an academic hospital in Monrovia, Liberia |
| title_fullStr | Surgical outcomes for perforated peptic ulcer: A prospective case series at an academic hospital in Monrovia, Liberia |
| title_full_unstemmed | Surgical outcomes for perforated peptic ulcer: A prospective case series at an academic hospital in Monrovia, Liberia |
| title_short | Surgical outcomes for perforated peptic ulcer: A prospective case series at an academic hospital in Monrovia, Liberia |
| title_sort | surgical outcomes for perforated peptic ulcer a prospective case series at an academic hospital in monrovia liberia |
| url | http://www.sciencedirect.com/science/article/pii/S2211419X14001384 |
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