Evaluating the Management of Perforated Peptic Ulcers in CHUK, Rwanda: Insights into Short-Term Clinical Outcomes

Authors:
Christophe MPIRIMBANYI, Miguel GASAKURE

Body of Abstract:
Background
Peptic ulcer perforation (PPU) remains a significant cause of morbidity and mortality globally, particularly in low- and middle-income countries (LMICs). Despite a decline in peptic ulcer disease incidence, PPU persists and is usually associated with higher morbidity and mortality. Despite that, there is still very limited data existing on PPU’s epidemiological and clinical characteristics as well as its management in Rwanda. Therefore, exhaustive clinical research would help to investigate this crucial matter further.
Methods
It was a retrospective cross-sectional study conducted only on adult patients diagnosed with PPU at the University Teaching Hospital of Kigali, Rwanda, between September 2022 and September 2023. Those patients were admitted and always followed by the General Surgery team. The data collection focused on demographics, clinical presentation, surgical management, postoperative complications, and outcomes were collected and then analyzed.
Results
The study involved 46 cases in total. It included predominantly male patients (80.5%) with a mean age of 36.8 years. The majority came from urban areas and had medical insurance. The intraoperative findings revealed the perforations occurring more predominantly in the prepyloric region (95.56%) and only around 4 % were found in the duodenal region.
All the cases were managed surgically. The surgical approaches of predilection were the Modified Graham patch (95.5%) or the primary repair (4.4%). Although most patients had no complications (75.5%), the most common postoperative complications were fever of unknown origin (13.3%), pneumonia (8.8%), and surgical site infection (4.4%). While most patients had uncomplicated postoperative courses, a 10% overall mortality rate was observed.
The average length of hospital stay was estimated at 6.67 days, with a standard deviation of 6.21 days. The range of hospital stays varied from 0 to 36 days. Only 8.6% were admitted to ICU and only 1 case had to be reoperated but no significant predictors for ICU admission or complications were identified.
Conclusions
This study highlights the burden of PPU in the biggest Teaching Hospital in Rwanda, CHUK. It emphasizes the need for early recognition, improved prevention, and management strategies for PPU. The high mortality rate underscores the critical nature of PPU. It also highlights the need to introduce new surgical approaches such as laparoscopic procedures. Further research is warranted, such as conducting a multi-center prospective study. This could help elucidate specific risk factors and optimize PPU treatment guidelines in Rwanda and in LMICs in general.