Factors influencing mortality in perforated duodenal ulcer following emergency surgical repair

Abstract

Duodenal perforation is a common abdominal catastrophe with excellent outcome if prompt
resuscitation and surgical repair of perforation are done. The aim of this study was to identify
factors associated with death after surgery in patients with duodenal perforation.
One hundred and forty-five patients who underwent Graham’s patch repair for perforated duodenal
ulcer between 14 April 2002 and 31 December 2004 were studied.
The mean age was 45.99 years and 61 patients (42.07 %) were referrals. There were 124 (85.52 %)
males and 21 (14.48 %) females. There were 10 deaths (6.9 %). The mean time delay was 2.46 days.
It was 2.37 days in survivors, 3.7 days in non-survivors. The time delay was 3.25 days for females
and 3.13 days for patients referred from another hospital. The mortality was significantly associated
with time delay between perforation and operation (p<0.01), presence of co-morbid conditions
(P<0.04), respiratory rate (p<0.02), raised blood urea (p<0.01) and serum creatinine (p<0.001), size
of perforation (p<0.005), amount of peritoneal fluid (p=0.003) and requirement of postoperative
intensive care unit support (p=0.003).
Time delay between perforation and operation, preoperative blood urea and serum creatinine,
size of perforation and amount of peritoneal fluid, presence of co-morbid conditions and need for
post operative ICU support are the important predictors of outcome after emergency surgery for
duodenal perforation.

Key Words: Acid peptic disease, duodenal perforation, Graham’s patch,
mortality, prognostic factors.