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Patterns and Seasonal Variations of Perforated Peptic Ulcer Disease: Experience from Ethiopia

Abebe Bekele, Daniel Zemenfes, Seyoum Kassa, Andualem Deneke, Mulat Taye, Sahlu Wondimu School of Medicine, Addis Ababa University, Ethiopia

Correspondence to:Dr. Abebe Bekele, P.O. Box 3560, Addis Ababa Ethiopia. Email: abebesurg@yahoo.com


Background: The free anterolateral thigh flap with its large caliber vessels, a reliable skin territory and minimal donor site morbidity is the reconstructive surgeons’ workhorse. The pedicled flap though not as popular, has been used extensively for the reconstruction of defects from the mid-leg to the epigastrium. The favorable profile of the anterolateral thigh flap, with minimal variability of its vascular anatomy and donor site complications is well described in most races; literature of its use in sub-Saharan Africa is scanty. Methods: The author describes the use of the anterolateral thigh flap in a series of 17 patients in a rural African hospital, illustrating its versatility as well as the complications associated with its use in this patient population. Results: Seventeen patients with

 Jones was performed in 83 (95.4%) of the patients. Atotal of 42 complications occurred in 20 (22.9%) of the patients, the commonest being wound infection. Ten (11.4%) underwent re-laparotomy. Nine patients (10.3%) died. Conclusion:This study has shown that perforated PUD affects young males who are smokers, alcohol users and khat chewers. It is also very common during the rainy Ethiopian months. We recommend further studies to study the interplay of these risk factors in the pathogenesis of perforations, especially their interaction with H.Pylori infection.

Key words: Perforated PUD, Omental Patch, Seasonal variation, risk factors,

Ann Afr Surg. 2017; 14(2):86-91


© 2017 Author. This work is licensed under the Creative Commons Attribution 4.0 International License.


Peptic Ulcer Disease (PUD) is a common disease of global public health concern. Literature shows that its incidence has been estimated at between 1500 and 3000 per 100,000 inhabitants per year (1, 2). There is a wealth of literature worldwide regarding the decrease in the incidence of uncomplicated peptic ulcer disease after the introduction of H-receptor antagonists in the 1970s; proton-pump inhibitors (PPIs) and the discovery of Helicobacter pylori (H. pylori) as a causative agent in the 1980s. Accordingly, the incidence of elective surgery for peptic ulcer has markedly decreased (1-3).

Surprisingly however, the incidence of and mortality from perforated peptic ulcer surgery has remained stable or even slightly increased (1-4) despite improvements in perioperative care. Acute perforations are reported in 2-10% of patients with ulcer disease and accounts for more than 70% of deaths associated with PUD (4, 5). The incidence of duodenal perforation is 7–10 cases/100,000 adults per year (2). The pattern of perforated PUD is said to vary from one geographic