Obstructing duodenal ulcers in a tropical population

Abstract

Objective: To characterise the pattern and pathology of obstructing duodenal ulcers in Zaria, Nigeria in the last sevlateen years.
Dexign: A retrospective study.
Setting: Department of Surgery, Ahmadu Bello University Teaching Ampital, Zaria, Nigeria
Patients: Fifty eight patients who had surgery for obstructing duodenal ulcer.
Results: The mean age was 36.6 years and female was ratio 3.6:1. The frequency of obstruction has been on an increase, reaching a peak in 1995 and has remained high. This period coincided with a fall in the frequency of perforation. Obstruction was due to cicatrisation in 48%, cicatrisation and adhesions in 28%, adhesions alone in 16% and inflammatory oedema in eight per cent. Three patients with adhesion had evidence of sealed or treated perforation. Seventy one per cent of the adhesions occured during the period of rapid rise in the frequency of obstructions. Truncal vagotomy and drainage was performed after three to five days nasogastric drainage of the stomach. Postoperative gastric atony occurred in one patient and mortality was 1.7%. There was one short term recurrence.
Conclusion: Gastric outlet obstruction is now the commonest indication for duodenal ulcer surgery in this population. Obstruction need not be due to cicatrisation alone. Peripyloric adhesion, perhaps from previous perforation is often tbe cause of obstruction.  Prolonged gastric drainage before and after surgery is not neccessary. Truncal vagotomy and drainage is an effective treatment.