Abstract

Background: Surgical emergency due to a perforated peptic ulcer is associated with a significant postoperative morbidity and mortality. Therefore, identification of risk factors in these patients provides surgeons with an important tool to plan the management. Our aim was to assess the predictors of the postoperative complications in surgically treated patients with perforated peptic ulcer. Patients and Methods: This is a prospective study conducted in Baghdad Teaching Hospital from August 2009 until January 2011.During this period all patients with acute abdomen who proved to have a perforated peptic ulcer were included in the study. A data form for each patient included the demographic characteristics of patients, illness and physical examination at time of presentation, preoperative resuscitation, type of surgery, operative finding s and postoperative complications. Results: 60 patients who proved to have perforated peptic ulcer and had emergency surgery were included in this study, 21 patients (35%) developed a total of 35 post operative complications that included one or more of the following: superficial wound infection (16)76%; respiratory complications (8)38%; burst abdomen (4)19%; hematemesis(4)19% ;postoperative fistula (2)9.5% and septicemia (1)5%. It was found that the risk of developing a postoperative complication was significantly influenced by the presence of a concomitant medical illness, abdominal distension and shock state on admission. Conclusion: Our study demonstrated that advanced age, abdominal distension, presence of concomitant medical illness and shock at presentation were the major and early clinical predictors of the postoperative complications in patients with perforated peptic ulcer, along with delayed presentation

Keywords

Surgical Emergency, Postoperative Morbidity and Mortality, Management