Acta Scientific Medical Sciences (ISSN: 2582-0931)

Research Article Volume 4 Issue 2

Predictors of Perforation in Duodenal Ulcer in Sudanese Patients A Single Center Experience

Elssayed Osman Elssayed Ahmed1* and Mohamed Elimam2

1Assistant Professor of General Surgery, Faculty of Medicine, Shendi University, Sudan
2Gezira University, Sudan

*Corresponding Author: Elssayed Osman Elssayed Ahmed, Assistant Professor of General Surgery, Faculty of Medicine, Shendi University, Sudan.

Received: December 31, 2019; Published: January 10, 2020



Background: For quite long period of time, treatment of peptic ulcer diseases mainly depend on surgery, advance in proton pump inhibitors and H. pylori eradication therapy, has led to less need of elective surgery. surgical treatment is often reserved for emergency complications of the disease. the incidence rate of perforated duodenal ulcer appears not to have changed, and still quite frequent in developing countries. Graham’s omental patch of the perforations is treatment of choice.

Objective: To determine the predictors of perforation in peptic ulcer.

Methods: A retrospective review of all patients with perforated duodenal ulcer seen at Almak Nimir university hospital between may 2014 to may2019. Patients' records were reviewed for demography, duration of disease, the probable risk factors and the type of surgery. Data were collected by a master sheet and was analyzed using SPSS 15.0.

Result: Twenty six patients were reviewed. All patients were males. The most common affected age was found to be 31 – 40 years of age (10 patients) (38.5%), followed by age 21 – 30 years (7 patients) (26.9%). A round 84.6% of patients were of a low socioeconomic class (18 patient), while 15.4% were of moderate socioeconomic class. 77% of the patients (20 patients) were manual worker (labors), 15.4% of the patients were farmers (4 patients).65.4% of the patients perforation occur during Ramadan (fasting).69.2% of the patients were smoker. no mortality was reported and 11.5% of the patient had complications.

Conclusion: Duodenal ulcer perforation in Sudan apparently was found to be a disease of middle aged men. Low socioeconomic class, manual workers, smoking and fasting were the main predictors of perforation in duodenal ulcer.

Keywords: Duodenal Ulcers; Perforations



  1. Søreide K., et al. “Strategies to improve the outcome of emergency surgery for perforated peptic ulcer”. British Journal of Surgery 101.1 (2014): e51-64.
  2. Thorsen K., et al. “Epidemiology of perforated peptic ulcer: age- and gender-adjusted analysis of incidence and mortality”. World Journal of Gastroenterology 19 (2013): 347-354. 
  3. Sarosi GA., et al. “Surgical therapy of peptic ulcers in the 21st century: more common than you think”. The American Journal of Surgery 190 (2005): 775-779. 
  4. Bertleff MJ and Lange JF. “Perforated peptic ulcer disease: a review of history and treatment”. Digestive Surgery 27 (2010): 161-169. 
  5. Siu WT., et al. “Single stitch laparoscopic omental patch repair of perforated peptic ulcer”. Journal of the Royal College of Surgeons of Edinburgh 42 (1997): 2-4.
  6. Slade_Howell H. “When repair is enough for perforated duodenal ulcer”. 64.11 (2008): 521-524. 
  7. Ng EK., et al. “High Prevalence Helicobacter pylori Infection in Duodenal Perforations not caused by Non-Steroidal Anti-Inflammatory Drugs”. British Journal of Surgery 83 (1996): 1779-1781.
  8. Ng EK., et al. “Eradication of Helicobacter pylori prevents recurrence of ulcer after simple closure of duodenal ulcer perforation: randomized controlled trial”. Annals of Surgery 231.2 (2000): 153-158.
  9. Lawal OO., et al. “Clinical pattern of perforated prepyloric and duodenal ulcer at Ile-Ife, Nigeria”. Tropical Doctor 28 (1998): 152-155. 
  10. Nuhu A., et al. “Acute Perforated Duodenal Ulcer in Maiduguri”. West African Journal of Medicine 28.6 (2009): 384-387. 
  11. DO Irabor. “An audit of peptic ulcer surgery in Ibadan Nigeria”. WAJM 24.3 (2005): 242-245.
  12. Griffin GE and Organ CH. “The Natural History of Perforated Duodenal Ulcer Treated by Suture Plication”. Annals of Surgery 183.4 (1976): 382-385.
  13. Plummer JM., et al. “Surgical management of perforated duodenal ulcer: the changing scene”. West Indian Medical Journal 53 (2004): 378-381. 
  14. Bin-Taleb AK., et al. “Management of perforated peptic ulcer in patients at a teaching hospital”. Saudi Medical Journal 29 (2008): 245-250.
  15. Di Saverio S., et al. “Diagnosis and treatment of perforated or bleeding peptic ulcers: 2013 WSES position paper”. World Journal of Emergency Surgery 45 (2014).
  16. Mehboob M., et al. “Peptic Duodenal Perforation-an Audit”. 6.101 (2000): 103.
  17. AE Dongo., et al. “A Five-Year Review of Perforated Peptic Ulcer Disease in Irrua, Nigeria”. Int Sch Res Notices 2017 (2017): 8375398. 
  18. Gali BM., et al. “Perforated peptic ulcer PPU-in pregnancy during ramadan fasting”. Nigerian Journal of Medicine 20.4 (2011): 497. 
  19. Gökakin AK., et al. “The impact of Ramadan on peptic ulcer perforation”. Ulusal Travma ve Acil Cerrahi Dergisi 18.4 (2012): 339-343. 
  20. Malik GM., et al. “Endoscopic Evaluation of Peptic Ulcer Disease During Ramadan Fasting: A Preliminary Study”. Diagnostic and Therapeutic Endoscopy 2.4 (1996): 219-221. 
  21. A Dodiyi-Manuel., et al. “Presentation and Management Of Perforated Peptic Ulcer Disease In A Tertiary Centre In South South Nigeria”. Journal of the West African College of Surgeons 5.3 (2015): 36-48. 
  22. Ohene-Yeboah M and Togbe B. “Perforated gastric and duodenal ulcers in an urban African Population”. West African Journal of Medicine 25 (2006): 205-211. 
  23. Lawal OO., et al. “Clinical pattern of perforated prepyloric and duodenal ulcer at Ile-Ife, Nigeria”. Tropical Doctor 28 (1998): 152-155.
  24. AC Etonyeaku., et al. “A review of the management of perforated duodenal ulcers at a tertiary hospital in south western Nigeria”. African Health Sciences 13.4 (2013): 907-913. 
  25. Griffin GE and Organ CH. “The natural history of perforated duodenal ulcer treated by suture plication”. Annals of Surgery 183 (1976): 382-385. 
  26. Bin-Taleb AK., et al. “Management of perforated peptic ulcer in patients at a teaching hospital”. Saudi Medical Journal 53 (2004): 378-381. 
  27. Walt R., et al. “Rising frequency of ulcer perforation among elderly people in the United Kingdom”. Lancet 3 (1986): 489-492.
  28. Chalya PL., et al. “Clinical profile and outcome of surgical treatment in perforated peptic ulcers in Northwestern Tanzania: A tertiary hospital experience”. World Journal of Emergency Surgery 6 (2011): 31.
  29. Gisbert JP., et al. “Helicobacter pylori and perforated peptic ulcer. Prevalence of the infection and role of non-steroidal anti-inflammatory drugs”. Digestive and Liver Disease 36.2 (2004): 116-120. 
  30. Svanes C. “Trends in Perforated Peptic Ulcer: Incidence, Aetiology, Treatment and Prognosis”. World Journal of Surgery 24 (2000): 277-283.
  31. Rosenstock S., et al. “Risk factors for peptic ulcer disease: a population based prospective cohort study comprising 2416 Danish adults”. Gut 52 (2003): 186-193. 
  32. Korman MG., et al. “Influence of cigarette smoking on healing and relapse in duodenal ulcer disease”. Gastroenterology 85 (1983): 871-874.
  33. Bae S., et al. “Incidence and short-term mortality from perforated peptic ulcer in Korea: a population-based study”. Journal of Epidemiology 22.6 (2012): 508-516. 
  34. Møller MH., et al. “The Peptic Ulcer Perforation (PULP) score: a predictor of mortality following peptic ulcer perforation. A cohort study”. Acta Anaesthesiologica Scandinavica 56 (2012): 655-662. 
  35. Thorsen K., et al. “Trends in diagnosis and surgical management of patients with perforated peptic ulcer”. Journal of Gastrointestinal Surgery 15 (2011): 1329-1335. 
  36. Lohsiriwat V., et al. “Perforated peptic ulcer: clinical presentation, surgical outcomes, and the accuracy of the Boey scoring system in predicting postoperative morbidity and mortality”. World Journal of Surgery 33 (2009): 80-85. 
  37. Kuremu RT. “Surgical management of peptic ulcer disease”. East African Medical Journal 76 (2002): 454-456.


Citation: Elssayed Osman Elssayed Ahmed and Mohamed Elimam. “Predictors of Perforation in Duodenal Ulcer in Sudanese Patients A Single Center Experience". Acta Scientific Medical Sciences 4.2 (2020): 80-85.


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