Background: Peptic ulcer perforation is a common surgical emergency condition worldwide, which is associated with significant morbidity and mortality if early diagnosis and immediate surgical management was not carried out. Perforation occurs in roughly 5% of PUD patients during their lifetime.
Methods: A 5 years Retrospective observational study on the clinical Presentation and Surgical Management of Peptic Ulcer Perforation in a Tertiary Hospital in Mogadishu- Somalia, department of General Surgery from January 2017 to December 2021. We included all patients undergoing operations with an intra-operative confirmed diagnosis of peptic ulcer perforation at the general surgery department. For operated patients, follow-up evaluation was performed in the outpatient department.
Results: Fifty-one patients underwent an emergency operation for peptic ulcer perforation during the study period. The socio-demographic distribution of patients was 45(88.2%) males and 6 (11.8%) females, giving a male to female ratio of 7.5:1.
The mean age of patients was 35.5±16.8 years, and the peak frequency was in the third decade. The commonest presenting symptoms were sudden onset of severe epigastric pain in 42 (82.4%) patients. Patients who presented perforated peptic ulcer within 24 hours of initiation of symptoms were free from complications.
Age group and delayed presentation > 48 hours after onset of symptoms were linked to post-operative complications and were statistically significant (P 0.032), (P0.005) respectively. Four patients died (mortality rate of 7.8%). Two patient was reoperated because of the failed primary repair and 4 patients had >5cm intra-abdominal abscess image-guided percutaneous drainage was performed and the rest antibiotic therapy according to peritoneal fluid culture and sensitivity results.
The most common microorganism isolated was E. coli 22% and Klebsiella 11%. Other rare microorganisms (pseudomonas, Staphylococcus aureus, and Candida spp) were identified. Half 51% of Peritoneal fluid culture no micro-organism growth was seen.
Conclusion: The distribution of peptic ulcer perforation is common in the young age group in the third decades of life. Delayed presentation of the disease is linked because most patients arrived from remote areas where proper facilities of health care and health education are not available and the patient might come to the hospital in an advanced stage of the disease. We suggest conducting further researches, health awareness related to complications over-the-counter drugs self-medication, and bad habit including smoking, and to improve health-seeking behaviors of society.