A modified open omental plugging of peptic ulcer perforation in a mission hospital, northwestern cameroon

Background: Perforated peptic ulcer disease is a common cause of emergency surgical admission with potential risk of grave complications.Management is often by surgical closure.The age-long controversy had been whether omentoplasty or omental patch is necessary or not?This study therefore brings to the fore the patterns of presentation and methods of management of perforated peptic ulcer as well as the outcome, in a resource-constrained mission hospital, Northwestern Cameroon.Methods: Retrospective cross-sectional study of patients with perforated peptic ulcer disease seen at St Elizabeth Catholic General Hospital, Shisong, Northwestern Cameroon over a three-year period from January 2016 to December 2018.Patients' records were reviewed for socio-demographics, probable risk factors, duration of disease, type of surgery and complications.Data obtained was analyzed using SPSS 22.0.Result: Eighty-eight patients were analyzed.The mean age was (number; n= 38 years ± SD 12.4 years).There were (n=64; 72.7%) males out of which (n=58; 65.9%) survived and (n=24; 27.3%) females out of which (n=20; 22.7%) survived and this difference was statistically insignificant (p>0.05).The Male: Female ratio was 3.0: 1. Mean age of survivors was 37.4 years and 43.7 years in those who expired.Farmers constituted the single largest group (n=38; 43.18%) followed by artisans (n=14; 15.70%), NSAIDs abuse (n=44), previous peptic ulcer disease (n=52) and no prior dyspeptic symptoms (n=36) constituted 50%, 60% and 40% respectively of cases.The age range was between 16 years and 74 years (The duration of symptoms before presentation ranged from 1 to 7 days; Fifty-two (n=52; 59%) patients had perforated duodenal ulcer while thirty-six (n=36; 41%) patients had perforated gastric ulcer.The preferred method of repair was simple closure of the edges with omental reinforcement in (n=58; 65.9%) patients.The classical Graham's omentoplasty in (n=20; 23%), and simple closure mainly in (n=10; 11.6%); we had three (n=3; 3.4%) failed repair and ten (n=10; 11.4%) mortalities.The presence of shock and sepsis is the single most important predictor of morbidity and mortality.Conclusion: Surgery for perforated peptic ulcer still is a subject of debate despite more than an era of published expertise.Our patients present very late and, in most cases, following abuse of local herbal preparation and Non-steroidal anti-inflammatory drugs.The presence of shock and sepsis is the single most important predictor of morbidity and mortality.Credence is being laid on the pragmatic surgical intervention with modified Graham's omentoplasty in addition to broad spectrum antibiotics and H. pylori eradication therapy is still highly beneficial in common practice.Health education to improve early health seeking habit is mandatory.