Perforated Peptic Ulcer Disease Research Articles

Antifungal Use in Perforated Peptic Ulcer Disease: A Western Australian Perspective.

Background Perforated peptic ulcer disease has a high mortality rate, and there is consensus regarding the use of antifungals in the management of immunocompromised patients; however, there is variability in the utilization of antifungals in the non-immunocompromised cohort. This study aims to describe the current practice related to the use of antifungals in perforated peptic ulcer disease in Western Australia and to determine the peri-operative morbidity and mortality in the immunocompromised and non-immunocompromised cohort receiving antifungals. Methods Medical records of patients who underwent surgical repair of perforated peptic ulcer in all Western Australian tertiary hospitals between January 1, 2010, and December 31, 2017, were reviewed retrospectively. Data regarding pre-operative patient factors such as age, gender, and comorbidities, post-operative outcomes such as intra-abdominal sepsis/bleeding, peri-operative antifungal prescription, and abundance of fungal growth on intra-operative samples were collected. Results The study included 359 patients. The antifungal prescription was variable. An American Society of Anesthesiologists (ASA) score of 3 or more, presence of pre-operative shock and acidosis, and level of abundance of fungal growth on intra-operative samples were associated with antifungal prescription. Amongst the non-immunocompromised cohort, receiving antifungals was associated with higher morbidity. Conclusion The use of antifungals for patients with perforated peptic ulcer disease was variable. An ASA score of 3 or greater and pre-operative shock and acidosis are pre-operative factors predisposing patients to receiving antifungals. There was no difference in morbidity or mortality amongst immunocompromised patients regardless of antifungal prescription or non-prescription. However, in the non-immunocompromised cohort, those who received antifungals had a higher morbidity compared to those who did not.

What is Valentino's syndrome?

AbstractThe eponym ‘Valentino's syndrome’ is used to describe patients with perforated peptic ulcer disease who present with right lower quadrant pain and suspected appendicitis. It is named for Rudolph Valentino, the film star who died on 23 August 1926 at the age of 31 from complications of perforated peptic ulcer disease. In the early 1920s, the Italian‐born actor had a meteoric rise to fame in the burgeoning film industry. His first starring role in the 1921 silent film, The Four Horseman of the Apocalypse, was a sensation and was followed quickly by a string of commercially successful movies. He was in good health until he presented with an acute abdomen in early August of 1926. He underwent a laparotomy and was found to have a perforated peptic ulcer that was repaired with simple closure and an omental patch. He initially rallied after surgery but ultimately died on the eighth post‐operative day from complications of sepsis. This manuscript will review Valentino's brief acting career, his medical history, and how the eponym which bears his name describes a disease presentation that is different from his actual clinical course.

Perforated peptic ulcer disease in transferred patients is associated with significant increase in length of stay.

Perforated peptic ulcer disease (PPUD) has a prevalence of 0.004-0.014% with mortality of 23.5% (Tarasconi et al. in World J Emerg Surg 15(PG-3):3, 2020). In this single center study, we examined the impact associated with patient transfer from outside facilities to our center for definitive surgical intervention (exploratory laparotomy). Using EPIC report workbench, we identified 27 patients between 2018 and 2021 undergoing exploratory laparotomy with a concurrent diagnosis of peptic ulcer disease, nine of which were transferred to our institution for care. We queried this population for markers of disease severity including mortality, length of stay, intensive care unit (ICU) length of stay, and readmission rates. Manual chart reviews were performed to examine these outcomes in more detail and identify patients who had been transferred to our facility for surgery from an outside hospital. A total of 27 patients were identified undergoing exploratory laparotomy for definitive treatment of PPUD. The majority of patients queried underwent level A operations, the most urgent level of activation. In our institution, a Level A operation needs to go to the operating room within one hour of arrival to the hospital. Average mortality for this patient population was 14.8%. The readmission rate was 40.1%, and average length of ICU stay post-operatively was 16days, with 83% of non-transfer patients requiring ICU admission and 100% of transfer patients requiring ICU admission, although this was not found to be statistically significant. Average length of hospital stay was 27days overall. For non-transfer patients and transfer patients, LOS was 20days and 41days, respectively, which was statistically significant by one-sided t-test (p = 0.05). Patients transferred for definitive care of PPUD in a population otherwise notable for high mortality and high readmission rates: their average length of stay compared to non-transfer patients was over twice the length, which was statistically significant. Transferred patients also had higher rates of ICU care requirement although this was not statistically significant. Further inquiry to identify modifiable variables to facilitate the care of transferred patients is warranted, especially in the context of improving quality metrics known to enhance patient outcomes, satisfaction, and value.

Associated Factors of Leaked Repair Following Omentopexy for Perforated Peptic Ulcer Disease; a Cross-sectional Study.

Previous studies have reported numerous clinico-pathologic risk factors associated with increased risk of leaked repair following omental patch for perforated peptic ulcer disease (PPUD). This study aimed to analyze the risk factors associated with leaked repair of omental patch and document the management and outcome of established cases of leaked repair in a resource-poor setting. This is a multicenter cross-sectional study of leaked repair after omental patch of PPUD between January 2016 to December 2022. Following primary repair of PPUD with omental pedicle reinforcement, associated factors of leaked repair were evaluated using univariate and multivariate analyses. Overall, 360 cases were evaluated (62.8% male). Leaked repair rate was 11.7% (42 cases). Those without immunosuppression were 3 times less likely to have leaked repair (aOR= 0.34; 95% CI: 0.16 - 0.72; p = 0.003) while those with sepsis were 4 times more likely to have leaked repair (aOR=4.16; 95% CI: 1.06 - 12.36; p = 0.018). Patients with delayed presentation (>48 hours) were 2.5 times more likely to have leaked repair than those who presented in 0 - 24 hours (aOR=2.51; 95% CI: 3.62 - 10.57; p = 0.044). Those with Perforation diameter 2.1-3.0 cm were 8 times (aOR=7.98; 95% CI: 2.63-24.21; p<0.0001), and those with perforation diameter > 3.0cm were 33 times (aOR=33.04; 95% CI: 10.98-100.25; p<0.0001) more likely to have leaked repair than those with perforation diameter of 0-1.0 cm. Similarly, in those with no perioperative shock, leaked repair was 4 times less likely to develop than those with perioperative shock (aOR= 0.42; 95% CI: 0.41-0.92; p = 0.041). There was significant statistical difference in morbidity (p = 0.003) and mortality (p < 0.0001) rates for cases of leaked repairs and successful repairs. Leaked repair following omentopexy for peptic ulcer perforation was significantly associated with large perforation diameter, delayed presentation, sepsis, immunosuppressive therapy, and perioperative shock.

Saline irrigation versus gauze wiping and suction only for peritoneal decontamination during laparoscopic repair for perforated peptic ulcer disease

The aim of current single-center study was to compare the short-term outcome of suction and gauze wiping alone versus the irrigation and suction technique for peritoneal decontamination among patients who underwent laparoscopic repair of PPU. Using data from our institution’s prospectively maintained database, 105 patients who underwent laparoscopic repair were enrolled in this study. The participants were further divided into the group who received peritoneal irrigation (irrigation group, n = 67) and group who received gauze wiping and suction only (suction only group, n = 38). The irrigation group had a longer operative time (140 vs. 113 min, p = 0.0001), higher number of drainage tubes (38.8% vs. 0%, p < 0.0001) and a higher incidence of intra-abdominal abscess (10.4% vs. 0%, p = 0.0469) than the suction only group. Peritoneal irrigation may be associated with a prolonged operative time and a higher number of abdominal drains. Meanwhile, gauze wiping and suction may be sufficient for peritoneal decontamination during the laparoscopic repair of PPU as further infectious complications are not observed.

Predictors of mortality for perforated peptic ulcer disease in Malawi

BackgroundMortality from perforated peptic ulcer disease (PUD) remains high, especially in sub-Saharan Africa. We sought to identify predictors of mortality following surgery for perforated PUD. MethodsWe performed a retrospective study of acute care surgeries at Kamuzu Central Hospital (KCH) in Malawi from 2013 to 2022. Patients undergoing omental patch surgeries were included. Bivariate and multivariate analyses were used to model predictors of mortality. ResultsA total of 248 patients were included. The mean age was 30 ± 15 years. Ninety percent were male. Mortality rate was 22.2%. Predictors of mortality included age (adjusted odds ratio [AOR] 1.06, 95% confidence interval [CI] 1.03–1.09), shock index (AOR 1.86, 95% CI 1.14–3.03), days to operative intervention (AOR 1.44, 95% CI 1.10–1.88), and presence of complications (AOR 9.65, 95% CI 3.79–24.6). ConclusionsMortality following surgery for perforated PUD remains high in this low-resource environment. In-hospital delay is a significant and modifiable predictor of mortality.

S3543 An Unusual Complication of Peptic Ulcer Disease

Introduction: In patients with severe peptic ulcer disease (PUD), perforation is a serious complication, often presenting with acute abdominal pain. Perforation occurs in approximately 5% of patients with PUD over their lifetime. Although fistulas have been reported as a potential complication of postoperative perforated peptic ulcer disease, we present a unique case of antral-abscess fistula complicated by duodenal adenocarcinoma. Case Description/Methods: A 57-year-old female presented to the hospital with a chief complaint of epigastric pain. The patient had a history of perforated gastric ulcer status post graham patch repair. Computed Tomography (CT) of abdomen revealed remote gastric perforation with chronic fistulous connection between the gastric antrum and an abscess along the superior margin of the gastric antrum, underneath the left liver. Upper GI endoscopy revealed diffuse mildly erythematous mucosa without bleeding in the stomach as well as non-bleeding large cratered chronic appearing duodenal ulcer with a clean ulcer base (Forrest Class III) in the duodenal bulb involving more than 90% of the duodenal circumference, causing narrowing at the duodenal sweep and 2nd portion of duodenum. There were multiple ulcer/mucosal changes spots of bluish/reddish concerning for non-bleeding visible vessel and fistula given the severity of the ulcer/mucosal changes. Subsequent duodenal ulcer biopsy revealed necrotic tissue with infiltrating cells which were significant for adenocarcinoma of the duodenum (Figure). Discussion: To our knowledge, this is the first report demonstrating antral stomach-abscess fistula with concomitant evidence of duodenal adenocarcinoma after perforated peptic ulcer disease. With this report, we not only aim to shed light on this unique complication but also to spark the scientific community to further investigate potential associations of duodenal adenocarcinoma including peptic ulcer disease.Figure 1.: Endoscopy of duodenum demonstrating ulcerations concerning for non-visible bleeding vessels and fistula.

Treatment outcome of perforated peptic ulcer disease among surgically treated patients: A cross-sectional study in Adama hospital medical college, Adama, Ethiopia

BackgroundPerforation is a life threatening complication of peptic ulcer disease which requires emergency admission and almost always urgent surgical intervention. It is associated with 30% mortality and 50% morbidity. The aim of this study is to assess treatment outcome of perforated peptic ulcers and its associated factors among surgically managed patients. Materials and methodsA 5 year, tertiary hospital-based, retrospective cross-sectional study was conducted on treatment outcome and associated factors among 106 patients operated for perforated peptic ulcers from 2015 to 2020. Omental patch, wedge excision and repair, and total gastrectomy were done by residents and/or consultants in 94, 11, and 1 patient respectively. Treatment outcome was considered favorable if the patient discharged improved and unfavorable if the patient developed complications/died. Logistic regression analysis was conducted to identify associated factors. ResultOut of 106 patients studied male to female ratio was 9:1. The mean age of patients was 36.13 ± 15.6years. Seventy-five (70.8%) patients presented after 24h of onset of symptoms. Most perforations were located on the first part of duodenum in 86 (81.1%) patients. Postoperative complications were identified in 30(28.3%) patients. Being female, delayed presentation, hypotension, and perforation site were significantly associated with postoperative morbidity (P < 0.05). Fifteen (14.2%) patients died in the hospital. Mortality was significantly associated with intra-operative level of contamination and development of post-operative complications (P < 0.05). Conclusionpostoperative morbidity and mortality were significantly associated with delayed presentation and postoperative complications.

Operative versus non-operative management for perforated peptic ulcer disease.

Perforated peptic ulcer (PPU) treatment guidelines are still up for discussion. Due to the morbidity and mortality linked to each, the use of both operative and non-operative management, including conservative and endoscopic treatment, is still debatable. A standardized protocol has been used to write a best evidence topic. The discussion focused on whether operative management for PPU is preferable to non-operational management or vice versa.MEDLINE, the Cochrane Library, Scopus, and the Web of Science were the databases used to conduct an electronic search of the pertinent literature.We found 56 articles, out of these only 5 studies were found to be appropriate to answer the question. The outcome assessed was failure of management. The best evidence showed that both operative and non-operative management can be used with similar outcomes depending on the patient selection for each category.

Perforated duodenal ulcer in the third trimester of pregnancy, with survival of both the mother and neonate, in Ethiopia: a case report

BackgroundPerforated peptic ulcer disease is a serious complication of peptic ulcer disease (PUD) that presents as acute abdomen. It is very uncommon during pregnancy, but its diagnosis in pregnancy is very challenging in general, and more so in the third trimester. Timely diagnosis and prompt surgical intervention can prevent maternal and fetal mortality, but delayed diagnosis is linked with poor maternal and fetal outcomes. The aim of this case report is to emphasize the need for healthcare professionals to consider the differential diagnosis of perforated PUD when presented with cases of acute abdomen in pregnancy and to involve a multidisciplinary team in management for better feto-maternal outcome.Case presentationA 35-year-old pregnant Ethiopian woman, Gravida 7 and Para 6, presented with a sudden onset of right upper quadrant pain, nausea, and vomiting of 7 hours duration at 36 weeks of gestation. She also had contractions and leakage of liquor of two hours duration. Her abdomen was grossly distended, rigid, and diffusely tender, and showed limited movement with respiration. An upright abdominal X-ray demonstrated air under the diaphragm. She was diagnosed with perforated peptic ulcer disease. Labor was augmented, and a 2.9-kg live male neonate was delivered vaginally. Two hours after delivery, laparoscopic omental patch repair was performed. The patient was discharged 7 days after the omental patch repair surgery in stable condition.ConclusionsPerforated PUD in pregnancy is a rare occurrence, which may account for the delay in diagnosis and management. Obstetricians should keep a high index of suspicion when a pregnant woman presents with acute abdomen. Care provided by obstetricians should be coupled with care provided by other disciplinary teams, in order to reduce maternal and fetal morbidity and mortality.

A Study on Liaison between Boey Score and Perforated Peptic Ulcer in View of Postoperative Morbidity and Mortality

Introduction Several factors associated with poor outcome in perforated peptic ulcer have been identified: delay in diagnosis, coexistent medical illness, shock on admission, leukocytosis, and old age. Such factors increase morbidity and mortality in perforated peptic ulcer disease. Careful resuscitation and perioperative optimization play a significant role in reducing morbidity and mortality associated with perforated peptic ulcer disease. Methods A prospective study of 60 cases who were operated for perforated peptic ulcer was done at Sheth L.G. Municipal General Hospital affiliated with AMCMET Medical College &amp; Research Centre, Ahmedabad. Categorization of these patients was done according to Boey score and their outcome was accessed. Objective The aim of this study was to appraise and analyze Boey score in operated cases of perforated ulcer disease. Results The morbidity and mortality rate in this study were 31.67% and 11.67%, respectively. The morbidity rate increased gradually with increase in Boey score: 8.69, 36.84, 50, and 62.5% for 0, 1, 2, and 3 score, respectively (p &lt; 0.01). The mortality rate was increased progressively with increasing Boey score: 0, 5.26, 30, and 37.5% for 0, 1, 2, and 3 score, respectively, and this relationship was statistically significant (p-value &lt; 0.01). The mean duration of hospital stay was 9.43 ± 4.10 days and p-value was less than 0.001. The area under curve in receiver-operating characteristic curve analysis was 0.854 and 0.751 for mortality and morbidity, respectively. Conclusion Boey score is simple, clinically relevant and can precisely predict postoperative morbidity and mortality and the length of hospital stay.

Primary versus delayed primary skin closure in operated patients due to perforated peptic ulcer disease: a randomized controlled clinical trial.

Perforated peptic ulcer (PPU) is a life-threatening complication of peptic ulcer disease. This condition is characterized by a dirty abdomen that predisposes to postoperative wound infection. Delayed primary skin closure is occasionally preferred over primary closure to reduce the risk of surgical site infection in dirty abdominal wounds. In primary skin closure, the skin is sutured immediately after surgery. Meanwhile, in delayed primary skin closure, the incision is left open, and sutured after 2-5days. The current research aimed to compare the risk for surgical site infection, length of hospitalization, and mortality rate between primary versus delayed primary skin closure among patients who underwent surgery for PPU. This single-blind randomized clinical trial included 120 patients who were randomly allocated into the primary and delayed primary closure groups. A research assistant who was blinded to the study examined the wounds for surgical site infection based on the 1992 Center for Disease Control criteria. The outcomes were mortality rate and duration of hospitalization. The delayed primary and primary closure groups did not significantly differ in terms of postsurgical wound infection occurring on the 3rd, 7th, 14th, and 30th days after surgery, mortality rate, and duration of hospitalization. In patients who underwent surgery for PPU, delayed primary closure is not recommended over primary closure due to the risk of postoperative surgical site infection.

PULP Score vs AAST EGS Grading System in Prediction of Outcome of Perforated Peptic Ulcer Disease: A Retrospective Study

Introduction: Peptic Ulcer Disease (PUD) is the most common diagnosis for upper abdomen pain, and it includes ulcerations and erosion in the Stomach and Duodenum. Complication such as Perforated PUD (PPUD) is only second to bleeding and remains a life-threatening emergency. Aim: To compare the American Association for the Surgery of Trauma– Emergency General Surgery (AAST EGS) scoring system with a widely accepted Peptic Ulcer Perforation (PULP) scoring system for PULP to determine the discriminative capacity and pairwise comparison of both scoring systems. Materials and Methods: This was a retrospective study conducted from September 2018 to August 2020 at Department of General Surgery, PES institute of Medical Science, Kuppam, Andhra Pradesh, India. All the adults diagnosed with perforated PUD were included. Preoperative, Intraoperative, and postoperative data were collected. The scores were generated for PULP and AAST EGS grades and analysed using Statistical Package for Social Sciences (SPSS) version 17.0. Spearman’s rho test evaluated a comparison of each variable with the AAST EGS grade. The pairwise comparison was performed for complication development, patient duration of stay, mortality and described using the Area Under the Receiver Operating Characteristic (AUROC) with 95% confidence intervals. Results: This study included 165 patients in this 87% male with a mean age of 56.89±16.79 years. All the total patients were divided into those &lt;=50 years (n=56,mean age:36.8±9.04 years) and &gt;50 years (n=109,mean age: 67.2±8.4 years) and comparative analysis was performed accordingly. Overall, the patients were categorised into the following AAST EGS grade I (9, 5.5%), grade II (99, 60%), grade III (42, 25.45%), grade IV (15, 9%), there were no patients with grade 5 AAST EGS. The AAST EGS grade was comparatively better them PULP score for postoperative complications, but there is not much difference between the PULP score and AAST EGS score for the patient's duration of stay. AAST EGS grade and the PULP discriminated, patient 30-day mortality similarly, but if Area Under Curve (AUC) &gt;0.8, it is a good predictor. Conclusion: The AAST EGS scoring system and the PULP scoring system do similarly predict mortality and complication. But the presence of many variables with points and tabulation which requires laboratory investigation makes PULP scoring system inconvieninent at bedside.

Study of factors to assess the mortality and morbidity in perforated peptic ulcer disease

Background: Perforated peptic ulcer (PPU) is one of the most common surgical emergencies worldwide more so in India. Despite of the decreased incidence of PPU due to proton pump inhibitors, H. pylori treatment regimen and improved awareness over the last decade, the morbidity and mortality of PPU still remain considerably high.Aim: To determine the preoperative and intraoperative factors affecting post-operative morbidity & mortality in patients operated for PPU.Materials & Methods: A prospective observational study of 140 patients who were operated for PPU was done. A detailed data based on age, history of smoking & alcohol intake, concomitant comorbid diseases, shock & abnormal renal function, duration of presentation to hospital after onset of symptoms, peritoneal contamination and size of perforation was obtained. All cases were followed up for a period of 6 months postoperatively for complications.Observation: Increased morbidity & mortality was observed in patients aged above 65 years. 44% of alcoholics had morbidity and 6.6% had mortality. 51.4% patients had concomitant comorbid diseases, of which 51.4% developed post-operative complications & mortality was 8.3%. 40% of cases presenting with shock had morbidity and 4.4% had mortality. 64.3% of cases presenting to hospital after 36 hours had either morbidity or mortality. Majority of patients with purulent peritoneal contamination had either morbidity or mortality. Perforation of size greater than 0.5cm2 showed morbidity in 44% & mortality in 16%. The overall morbidity and mortality of our study is 35% (n=49) and 5% (n=7) respectively.Conclusion: Risk factors for morbidity and mortality in PPU are elderly age, alcoholism, associated medical illness, pre-operative shock & sepsis, improper fluid resuscitation, perforation to surgery interval more than 36 hours, purulent peritoneal collection & perforation of size >0.5 cm2. Important post-operative factors increasing morbidity and mortality include respirat

Ulcère Perforé-Bouché: A Case Report

Ulcère Perforé-Bouché: A Case Report

Seasonal Variation of Presentation of Perforated Peptic Ulcer Disease: An Overview of Patient Demographics, Management and Outcomes.

BackgroundPerforated peptic ulcer disease (PUD) is one of the most common causes of acute peritonitis. It carries significant mortality and morbidity. Several previous studies have reported a seasonal variation in the presentation of patients with perforated ulcers. Here we present this study from our experience in a Northern Irish acute district hospital.MethodsA retrospective cohort study was conducted on perforated peptic ulcer patients who presented to Altnagelvin Area Hospital emergency department between 2015 to 2020. Data on patient demographics, clinical presentation, investigations, management and outcomes were collected. Primary outcome was to investigate if seasonality was associated with the incidence of perforated peptic ulcers. Follow-up data were also collected. Seasons were defined as per UK Met Office.ResultsA total of 50 patients presented with perforated PUD. Male to female ratio was approximately 3:2. Peaks were noted in spring and winter. April was the most common month for presentation followed by December. Smoking was the most common risk factor followed by alcohol abuse. Fourteen patients (28%) were either very frail or had contained perforations and were conservatively managed. Three deaths were noted (6%). Thirteen patients (26%) required ICU admission at some stage in their management.ConclusionSlight seasonal variation was noted in the presentation of perforated peptic ulcers in our study with a higher incidence in the winter and spring months. The month of April was noted to have the peak incidence of the disease in our study.

Risk Factors for Gastrointestinal Leak after Perforated Peptic Ulcer Disease Operative Repair.

There are limited studies regarding the impact of post-operative leak on perforated peptic ulcer disease (PPUD) and conflicting results regarding routine drain placement in operative repair of PPUD. This study aims to identify risk factors for gastrointestinal leak after operative repair of PPUD to better guide intra-operative decisions about drain placement. We performed a retrospective cohort study at a tertiary care center from 2008 to 2019, identifying 175 patients who underwent operative repair of PPUD. Patients who developed a leak (17%) were compared to patients who did not. Both hypoalbuminemia (albumin < 3.5g/dL) (P = .03) and duodenal ulcers (P < .01) were identified as significant risk factors for leak. No significant difference was found between leak and no leak groups for AAST disease severity grade, repair technique, or pre-operative use of tobacco, alcohol, or steroids. Post-operative leaks were associated with prolonged hospital stay (29days compared to 10, P < .01), increased complication rates (77% compared to 48%, P < .01), and increased re-operation rates (73% compared to 26%, <0.01). No difference was identified in patient characteristics or operative leak rates between patients who had drains placed at the index operation and those that did not. Leak after operative PPUD repair is associated with significant post-operative morbidity. Hypoalbuminemia and duodenal perforations are significant risk factors for post-operative leaks.

Seasonal variation in emergency surgical conditions

AbstractAimSeasonality has been shown to affect incidence of emergency surgical conditions in the West. There is yet no local data to suggest the causal relationship between seasonality and emergency surgical conditions. We aim to investigate on the effects of seasonal variation on common general surgical conditions for (i) ruptured abdominal aortic aneurysm, (ii) perforated peptic ulcer disease, (iii) ischaemic bowel, and (iv) acute cholecystitis in the New Territory West Cluster (NTWC).MethodThe present study was a retrospective study of 7653 patients who underwent emergency operations from 1 July 2008 to 30 June 2018 in the NTWC. Seasonality was defined according to the Chinese lunar calendar. Seasonal variation in the aforementioned surgical conditions were studied by emergency operations performed and recorded by the cluster's Surgical Outcomes Monitoring and Improvement Programme (SOMIP) data. The primary outcome is to analyse the presence of overall seasonal variation across the four seasons for each surgical condition by the goodness of fit test. The secondary outcome is to analyse the relationship of each season (Spring, Summer, Fall, Winter) and extreme weather condition, in this study, the cold weather warning signal, on the surgical conditions by the 2 × 2 Chi‐square test.ResultsFor primary outcome, statistically significant variation exists in all general surgical conditions except ischaemic bowel across the four seasons. For secondary outcomes, statistically significant relationships exist between each season and different surgical conditions. Moreover, cold weather warning has a statistically significant relationship with emergent surgeries for perforated peptic ulcer disease and ruptured abdominal aortic aneurysm.ConclusionThere is seasonal variation in emergency surgical conditions.

SP10.2.8 Trainee led Emergency Laparotomy operating; does it impact on outcomes?

Abstract Introduction To achieve completion of training in general surgery, trainees are required to demonstrate competency in common procedures performed at Emergency Laparotomy (Em Lap). We describe the patterns of trainee led emergency laparotomy operating and the association between post-operative outcomes. Methods All patients who had an Em Lap were extracted from the National Emergency Laparotomy Audit database from December 2013 to November 2017. Patients were grouped by grade of operative surgeon; trainee (speciality registrar) or Consultant (including Post Certificate of Completion (CCT) fellows). Trends in trainee operating by education deanery, hospital size and time of day of surgery were investigated. Adjusted regression analysis for the outcomes of 90-day mortality and return to theatre in operative subgroups of segmental colectomy, Hartmann's procedure, adhesiolysis and repair of perforated peptic ulcer disease were performed. Results The study cohort contained 95 520 patients. There were no increased odds of death by 90 days or of return to theatre across any of the operative groups when a trainee was listed as the most senior surgeon present in theatre. Trainees were more likely to operate independently in the Welsh deanery, high volume centres and at night (all P &amp;lt; 0.001). Conclusion There is significant variation in trainee led operating in Em Lap cases by deanery, hospital size and by time of day. However, this involvement in cases required for CCT in general surgery does not appear to impact on mortality or return to theatre in patients when adjusting for various pre-operative features.

Pattern of Presentation, Management and Early Outcome in Patients with Perforated Peptic Ulcer Disease in a Semi-urban Tertiary Hospital.

Perforated peptic ulcer is a life-threatening complication with a high morbidity and mortality. It is the most common indication for emergency operation in peptic ulcer disease (PUD) patients. This study aimed to describe the pattern of presentation, management and early outcome in patients with perforated PUD. This was a prospective study of patients who had operation for perforated PUD at Ekiti State University Teaching Hospital (EKSUTH), Ado-Ekiti, Southwestern Nigeria from June 2015 to May 2020. Forty-six patients were studied with their ages ranging from 21-85 years. Their mean age was 49.9±16.3 years while the median was 54 years. Males outnumbered females by a ratio of 5.5:1. Majority (56.5%) of the patients were farmers and artisans. Duration of symptoms was 6 hours to 9 days (mean 2.7±1.9 days). Non-steroidal anti-inflammatory drugs use, herbal concoction, alcohol and smoking was found in 54.3%, 52.2%, 30.4% and 21.7% respectively. More duodenal perforations (63.0%) were recorded. Graham's patch closure was done for 27 (58.7%) while the remaining (41.3%) had primary closure with omentoplasty. Sixteen (34.8%) had postoperative complications with wound infection predominating. Overall postoperative mortality was 17.4%. Age ≥ 60 years (p=0.04), premorbid illness (p=0.01), delayed presentation ≥ 48 hours (p=0.01), shock (p=0.01) and intraperitoneal effluent ≥ 2000ml (p=0.03) were associated with mortalities. Perforated PUD accounts for high morbidities and mortalities in our setting. Abuse of NSAIDs and herbal concoction ranked highest among the risk factors. Efforts at curtailing indiscriminate sales of NSAIDs and herbal concoction will reduce the menace.