Duodenal Perforation among Patients of Acid Peptic Disease

Muhammad Tahir Ali; Umair Masood; Muhammad Saif ul Malook; Azam Ali; Safdar Baig

doi:10.29054/apmc/2012.453

Muhammad Tahir Ali Assistant Professor of Surgery Q.A.M.C/ B.V.H Bahawalpur 29 Doctors Lodge BVH Bahawalpur
Umair Masood Postgraduate Resident B.V.H, Bahawalpur
Muhammad Saif ul Malook Postgraduate Resident B.V.H, Bahawalpur
Azam Ali Department of Biochemistry KEMC, Lahore
Safdar Baig Department of Dentistry B.V.H, Bahawalpur

DOI: https://doi.org/10.29054/apmc/2012.453

Keywords: Duodenum, Ulcer, Perforation, Antiulcer drugs

Abstract

Introduction: Duodenal ulcer (DU) perforation is one of the severe complications of duodenal ulcer. Although, antiulcer drugs reduce the risk of duodenal ulcer perforations but perforation may occur in 2-10% patients taking antiulcer drugs. In elderly patients of duodenal ulcer perforation, the mortality remains 30-50% in-spite of optimal management. Objective: To find out the frequency and characteristics of patients with duodenal ulcer perforation on regular anti ulcer drugs, on irregular therapy and in those not taking medications for acid peptic disease. Study Design: Cross sectional study(Hospital based). Study Setting: Department of Surgery, Bahawal Victoria Hospital, Bahawalpur. Duration of Study: From 11-02-2009 to 10-01-2010. Subjects and Methods: Fifty five patients of Duodenal Ulcer perforation diagnosed on clinical ground and Laparoscopy/Laparotomy with known history of peptic ulcer, whether taking antiulcer drugs (complete or incomplete course) or not, were included in this study. All the data was recorded on pre-designed Proforma and results were analyzed using SPSS 13.0 version. Results: 55 patients were operated for perforated duodenal ulcer during the study period in the surgical department of Bahawal Victoria Hospital, Bahawalpur. This consisted of 50 males (91%) and 05 females (09%). Themale/female ratio was 10:1; the patients were aged 20-60 years. The peak incidence was in the 5^th decade. Duration of acute symptoms before presentation was a few hours to 5 days. None of the perforations was associated with recent ingestion of non steroidal anti-inflammatory drugs (NSAIDS). There was a history of chronic peptic ulcer disease in 39(71%) patients. Abdominal tenderness and classical signs of peritonitis were demonstrable in 49(89.1%) and 46(83.6%) patients respectively. Plain abdominal and chest x-rays were carried out for all these patients, with free gas under the diaphragm demonstrated in 70% percent of cases. A total of 49 patients (89%) had anterior pyloroduodenal perforations with serous peritoneal fluid in 29 (53%), cloudy/opalescent peritoneal fluid in 13 (24%) and frank peritoneal pus with fibrinoid adhesions in 13 (24%) patients. Six of the perforations were found to be sealed. Five of the perforations were of size </=5mm and 44 were >10mm in size. Only six patients out of fifty five (11%) during or after a course of the antiulcer drugs developed Duodenal Ulcer Perforation. Conclusion: Duodenal ulcer perforation may occur in patients who were taking antiulcer drugs. Duodenal ulcer perforation is more common in patients with acid peptic disease who were not taking antiulcer drugs.