Management of peptic ulcer

Perforated duodenal ulcer; management in a resource poor, semi-urban nigerian hospital

INTRODUCTION

Perforated duodenal ulcer (PDU) is still seen frequently in the study center inspite of the free use of effective medical curative therapy. We then set out to ascertain the pattern of presentation, peculiar risk factors in the study environment, re-evaluate our method of management, and to see if it is adequate for patients in a developing country.

MATERIALS AND METHODS

This is a retrospective study of patients admitted and managed for PDUs, between January 2004 and December 2011 at the Federal Medical Centre, IdoEkiti, Southwest Nigeria. The records of patients were retrieved and demographic data relating to age, sex, symptoms, duration, diagnosis, intra-operative findings, and management outcome were extracted. The results were analyzed.

RESULTS

A total of 30 patients were admitted and operated during this period. Twenty-eight of them were males and two were females. The mean age was 47 years and the male: female ratio was 14:1. The duration of symptoms before presentation ranged from 2 to 7 days. None of the patients had a prior diagnosis of their ulcers, by an upper gastro intestinal endoscopy before presentation; although most had dyspeptic symptoms, with inadequate or no medical treatment. The notable peculiar risk factor was the abuse of local herbal concoction for body pains by all the patients. Seven patients smokes, 15 consumes alcohol, and only two take non-steroidal anti-inflammatory drugs for body pains. Most of the managed patients; 26 were satisfactorily discharged home and later followed-up at the surgical out-patient department. Four mortality was recorded during the period of study.

CONCLUSION

PDU is still a major complication of chronic peptic ulcer disease. Simple omental patch and H. pylori eradication is no longer appropriate as a mode of treatment for the youths who are mostly affected in the center. We therefore, suggest a more wide spread use of definitive ulcer surgery for most of our patients with no pre-operative risk factors.

Recent developments in upper gastrointestinal surgery

Important changes have occurred in the field of upper gastrointestinal surgery in the past few years. The change with the greatest impact has been the introduction of laparoscopic/thoracoscopic surgery in the treatment of the functional upper gastrointestinal disorders. However, new therapies in such diverse fields as bleeding oesophageal and peptic ulcer disease have greatly lessened the role of the surgeon in the elective setting. Malignant disease of the upper gastrointestinal tract has shown a marked swing away from cancer of the stomach towards cancer in the region of the gastro-oesophageal junction. There remains no consensus on the place of radical surgery in the treatment of these conditions.