Acute Perforated Duodenal Ulcer in Maiduguri: Experience with Simple Closure and Helicobacter pylori Eradication

Abstract

BACKGROUND: Effective medical management of peptic ulcer disease (PUD) has reduced the incidence of gastric outlet obstruction (GOO) as a complication, but perforation especially in the elderly remains unchanged and is in fact on the increase. There is a changing trend in emergency surgery for perforated duodenal ulcer (PDU) from definitive anti-ulcer surgery to simple closure followed by Helicobacter pylori eradication. OBJECTIVE: To present our experience in managing PDU with simple closure followed by Helicobacter pylori eradication.
METHODS: This was a chart review of patients managed for PDU over a nine-year period (Jan 1999–Dec 2007) using information obtained from ward admission registers, theatre operation registers, and patients’ case files from the medical records department. The patient’s biodata, clinical, and operative findings as well as treatment outcome were extracted for analysis. RESULTS: Of 55 patients eligible for analysis, 44 (80%) were males and 11(20%) females (M: F=4:1). Their ages ranged between 18 and 65 years with a mean ± SD of 39.9 ±13.5 years. Most of the patients [34 (61.8%)] were below 40 years of age and majority 39(71.0%) had a history suggestive of chronic peptic ulcer disease. Twenty-six (47.3%) patients presented within 24 hours of perforation, while nine (16.4%) presented more than 72 hours afterwards. The latter group accounted for most [five(55.6%)] of the mortality. All the perforations were anterior pyloroduodenal and all except one had simple closure with omental patch followed by a course of a proton pump inhibitor and Helicobacter pylori eradication therapy. CONCLUSION: Simple closure with omental patch followed by Helicobacter pylori eradication is effective in managing PDU
with low morbidity and mortality despite patients’ late presentation in our center. This technique is recommended in place of a definitive ulcer surgery.

WAJM 2009; 28(6): 384– 387.

Keywords: Helicobacter pylori, duodenal ulcer, perforation of, management, open simple closure, outcome.