Most perforations were located on the duodenum {78, 92.9%), whereas in the remaining six (7.1%) patients had their ulcers located on the stomach.

The duodenal to gastric ulcers ratio was 12.7: 1. The majority of patients, 82 (97.6%) had single perforation and the remaining 2 (2.4%) patients had both duodenal and gastric perforations. The mean age of the patients with gastric ulcers (56.4 ± 12.5) was significantly higher than that of those with duodenal ulcers (32.8 ± 14.4) (P = 0.002). The median size of the ulcer was 5.4 mm (2-20 mm). Seven (8.3%) of the perforations were found to be sealed. Thirteen (15.5%) BMN 673 in vivo of the perforations were of minimal size (≤5 mm) and sixty-four (76.2%) were massive (>10 mm). All perforations were found adhered with omentum and the nature of peritoneal fluid was sero- sanguineous in 34 (40.5%) patients, bilious in 28 (33.3%) patients and purulent in 14 (16.7%) patients. The amount of peritoneal fluid varied from 500 to 1000 mls with a median of 564 mls. The nature of peritoneal fluid was not documented in 8 (9.5%) patients. Histological examination of the biopsy specimens revealed no malignancy. All biopsies were not stained for Helicobacter

pylori. Surgical treatment The majority of patients, 70 (83.3%) had Graham’s omental patch of the perforations with either a pedicled omental patch or a free graft of omentum. Those Trametinib purchase with sealed perforations had peritoneal lavage with warm saline and mass closure of the abdomen. One patient had truncal vagotomy and Roux-en-Y gastro-jejunostomy in addition to simple closure. One patient who had a large ulcer, which penetrated to the pancreas and caused pyloric obstruction, underwent subtotal gastrectomy. Outcome of Treatment Post-operative

complications were recorded in 25 (29.8%) patients. Of these, surgical site infection (48.0%) was the most common post-operative complications (Table 2). The mean age of patients who developed complications was 52.4 ± 16.4 years, whereas the mean age of patients without complications was 32.6 ± 10.2 years. This age difference was statistically significant (P = 0.011). The complication rates for 0, 1, 2 and 3 Boey scores were 8.0%, 12.0%, AMP deaminase 20.0% and 60.0%, respectively (P = 0.002, Pearson χ2 test) Table 2 Post-operative complications (N = 25) Complications Frequency Percentage Surgical site infections 12 48.0 Post-operative pyrexia 9 36.0 Pulmonary infection 7 28.0 Intra-abdominal abscess 5 20.0 Wound dehiscence/burst abdomen 5 20.0 Re-perforation 4 16.0 Septic shock 3 12.0 Enterocutaneous fistula 3 12.0 Peritonitis 3 12.0 Incisional hernia 2 8.0 Cardiopulmonary arrest 2 8.0 Acute renal failure 1 4.0 Paralytic ileus 1 4.0 Table 3 shows predictors of complications according to univariate and multivariate logistic regression analysis. The overall length of hospital stay (LOS) ranged from 1 to 48 days with a median of 14 days.