One hundred twelve patients were operated within three years period in Dessie referral hospital. On average thirty four cases presented annually with slightly higher incidence than in Irrua Nigeria and Tanzania (7, 12). These differences based on variations in risk factors for perforated peptic ulcer disease. All patients admitted with complain of sudden onset of abdominal pain as well as nausea (75%), vomiting (78%), and abdominal tenderness (97%). This finding is consistent with a study done at Zewditu hospital (9). Study done in Tanzania (7) was also comparable with abdominal pain (97%), vomiting (37%), and tenderness (88%).
In this study duodenal ulcer perforation was the most common type of perforation with a duodenal to gastric ulcer ratio of 11.5:1. This is comparable to a study in Zewditu memorial and Tanzanian hospitals, the reported ratio were 8.5:1, 12.7:1 (7, 9) respectively. In other way a study done Irrua Nigeria reported high incidence of gastric ulcer perforations than duodenal ulcer perforation with 2:1(12).
Pedicle omental patch was the most common choice of operation through the three years period (97%). It is easier, fast and end with acceptable complications. Similar surgical treatment pattern were reported in Tanzania and Jaipur India (7, 18).
Overall, eighteen (17.8%) patients were developed postoperative complications in this study with 95% CI (10.5, 25.2). It is in line with studies done in Turk in different sites 20.3% and 23% respectively (3, 5) but lower than studies done in Tanzania(29%) and Zewuditu memorial hospital (31%) (7,9). Respiratory infection (25.8%), surgical site infection (20.7%), wound dehiscence (12.06%) and abscess formation (13.8%) were the commonest complications, which is consistency with a study done in New Delhi, India, were reported that superficial surgical site infection (28%), pneumonia (30%), and wound dehiscence (20%) (18).
Post operated perforated peptic ulcer (PPU) complication occurred commonly in younger age group in the current study which is six times more likely to developed complications than those whose age group greater than fifty years. Median age in this case 28 years which is comparable with studies done in Côte d’Ivoire, Minilik Hospital and Tanzania with median age of 34, 33.5 ,32.4 years respectively (7,11,17). This may be attributed to demographic profile of high H. pylori infection, smoking, drinking alcohol in younger age groups than adults to increase risk of PPU and it is comparable with study done in Black lion and Nigeria Hospitals (2, 12)
Mortality rate after surgical management of perforated peptic ulcer were 4% with 95% CI (1.00, 7.90). It is in agreement with studies done in India (5.2%), Turkish (5.8%) but lower than studies done in Tanzania (10.7%), Irrua, Nigeria (17.3%) (3, 7, 12, 18). Mortality was high in patients with age ≥ 50 years and concomitant diseases, which is similar with a study done in Tanzania (7).
Delayed presentation after 48 hours increase both post-operative complication and mortality which is comparable with a study done in Tanzania (7). Patients may take medications in the pre-hospital period to hope those symptoms to be abate. It is also possible that some clinicians managing patients initially may not have considered perforation as a possible diagnosis.
Post operated perforated peptic ulcer (PPU) complication occurred commonly in younger age group in the current study which is six times more likely to developed complications than those whose age group greater than fifty years. Median age in this case 28 years which is comparable with studies done in Côte d’Ivoire, Minilik Hospital and Tanzania with median age of 34, 33.5 ,32.4 years respectively (7,11,17). This may be attributed to demographic profile of high H.pylori infection, smoking, drinking alcohol in younger age groups than adults to increase risk of PPU and it is comparable with study done in Black lion and Nigeria Hospitals (2, 12)
Co-morbid illnesses have ten times more significantly associated with outcome of perforated peptic ulcer disease. Seven percent of patients in the current study were presented with comorbid illnesses. It is similar with a study done in Tanzania (7%) but much lower than that of Côte d’Ivoire 73%, (7, 11). These differences may be due to health care system accessibility of services especially media, health care facilities and health care providers to prevent, treat and giving care early.
Lower blood pressure was another risk factor on the development of complications due to post-operative perforated peptic ulcer disease. Patients who have low systolic blood pressure were five times more likely to develop complications in this study.
Average preoperative hospital stay also has a contribution for the occurrence of complication after surgical management among perforated peptic ulcer disease patients. It is two times more likely to develop complication in this study. The average hospital stay of the patients was 6 days which has slight improvement as compared with perforated peptic ulcer disease at Zewditu memorial hospital 14.5 days (9), reason could be low co-morbidity illnesses in this study. Small sample size and as usual being retrospective study are limitation of this study.