Risk Factors for Post Operative Complications in Patients of Perforated Duodenal Ulcer

Background: Perforation of peptic ulcer is a life threatening emergency and associated with increased surgical morbidity. Objective: To determine the risk factors of post postoperative complications in patients of perforated duodenal ulcer. Methodology: A cross sectional study was conducted at Surgical Department of Sheikh Zayed Hospital, Rahim Yar Khan and th started on 12 February 2013 and completed in 6 months. Clinically, radiologically and surgically proven, 133 cases of the perforated peptic ulcer were included in the study through non probability consecutive sampling after taking informed consent. Possible predictors were recorded on admission as well as during surgery. Main outcome measures were postoperative complications which included respiratory tract infection, wound infection, and burst abdomen. Data was entered and analyzed by using SPSS version 14. Results: Age range of study subjects was 26-70 years. 80% of the patients were male and 20% female. 27.8 % of the cases had clinical features of shock at presentation. Majority of the cases 65% presented within 48 hours. Smoking was noted in 51.9% of the cases. 74% had no associated medical illness. In 96% of the cases the size of perforation was less than 1 cm. Amount of peritoneal Spillage was greater than 1 liter in more than half patients (62%). First part of the duodenum was the most common site of the perforation, which was present in 88% of the cases. Graham's omentopexy was done in 95% cases. 53 (40%) cases developed postoperative complications. 31 cases developed 1 complication each, 17 cases developed 2 complications each while 5 cases 3 complications each. The most common complication was respiratory tract infection which th th occured in 26 patients (19.6%). Most of the patients were discharged home between the 5 and 10 postoperative days. Those patients who presented in emergency after duration of 48 hours since onset of epigastric pain had very significant association with postoperative complication rate ( p=0.0001). Other factor which showed significant association was shock at presentation (pvalue= 0.004). Conclusion: Late presentation and presence of shock significantly influence the rate of development of post operative complications in patients of perforated duodenal ulcer. However, smoking and presence of medical illness failed to show significant association with postoperative complications.