Clinical Presentation and Management of Patients with Peptic Ulcer Perforation in Kashmir - A Prospective Study

Author(s): Abdul Rashid Ganaie1, Zuneera Banoo2, Aamir Hussain Hela3, Ishfaq Ahmad Hakeem4, Haseeb Mohammad Khandwaw5

Around 4 million people are affected by peptic ulcer diseases worldwide annually.
The incidence of around 1.5 % to 3 % has been estimated. Peptic ulcer perforation
presents with an overall mortality of 10 %. The management is also associated
with significant post-operative morbidity and mortality regardless of whether
laparoscopic or open repair is performed. In this study, we wanted to find out the
incidence of peptic ulcer perforation and its management.
Our study was a prospective observational study conducted in post graduate
Department of Surgery, Government Medical College Srinagar, from October 2018
to November 2020. All patients were evaluated properly with all baseline
investigations followed by X-ray chest and abdomen and ultrasonography (USG).
In our study, 136 patients were diagnosed as cases of peptic ulcer perforation.
The maximum number of patients were in age group of 41 - 50 years (27.20 %).
The male : female ratio was 14.1 : 1. Abdominal pain was present in all patients
as presenting symptom followed by abdominal distension. In this study, 124
patients (91.2 %) had perforation in first part of duodenum, 9 patients (6.6 %)
had perforation in prepyloric region and 3 (2.2 %) patients had perforation in body
of stomach. Graham’s Patch repair was done in 133 patients, 1 patient underwent
primary closure, and 2 patients underwent distal gastrectomy with
Our study shows that young people with perforated peptic ulcer have fewer coexisting
medical illness, a lower complication rate and a more favorable outcome
as compared to elderly patients with perforated peptic ulcer. A majority of such
perforations are in 1st part of duodenum with male preponderance. A plain chest
radiograph is sufficient to make diagnosis in the classic case of sudden onset
epigastric pain.