Determinants of morbidity and mortality in perforated peptic ulcer disease: A retrospective study at Jimma University Medical Center, Ethiopia

Determinants of morbidity and mortality in perforated peptic ulcer disease: A retrospective study at Jimma University Medical Center, Ethiopia | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Determinants of morbidity and mortality in perforated peptic ulcer disease: A retrospective study at Jimma University Medical Center, Ethiopia Gutu Ganati Tola, Temesgen Temitim Demis, Zemzem Mohammed Selamo, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8747676/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background Peptic ulcer disease (PUD) is a common disease, which is a global public health concern. Whereas perforated peptic ulcer disease (PPUD) is a significant surgical emergency in low-resource settings, with high morbidity and mortality. Risk factors and outcomes differ from high-income countries due to variations in healthcare access, patient behaviour, and surgical practice. Materials and methods A tertiary hospital-based, retrospective, cross-sectional study was conducted over 5 years. The sample size (n = 102) was calculated using a single population proportion formula, based on expected PPUD outcome, a 95% confidence level, and 5% margin of error. Demographic, clinical, intraoperative, and postoperative data were analyzed. Associations between patient factors, perforation characteristics, surgical procedures, and outcomes were assessed using multivariate logistic regression. Result Most patients were young males (mean age 35.4 years). 57.8% of the patients presented more than twenty-four hours later. Eighty-one patients (79.4%) had perforations on the anterior first part of the duodenum. For the majority, 86(84.3%) of the patients repair was done with omental pedicle alone. Post-operative complications were recorded in thirty seven (36.3) patients. Significant predictors of adverse outcomes were delayed presentation, advanced age, hypotension at admission, large perforation size, and type of surgical procedure. Conclusion PPUD in our setting predominantly affects young males and duodenal ulcers whereas delayed presentation contributed to high morbidity. Pedicled omental patch repair remains the mainstay of treatment. In order to reduce complications and mortality in resource-limited settings, improving early recognition, timely referral, and perioperative care are crucial. Perforated peptic ulcer disease omental patch surgical outcomes morbidity mortality Figures Figure 1 Figure 2 Figure 3 1. Introduction Peptic ulcer disease (PUD) refers to ulcers of the stomach and duodenum. It is the result of an imbalance of acid-pepsin secretion and mucosal defenses that protect from acid digestion. It is a common disease and a global public health concern. The natural history of peptic ulcer disease ranges from a spontaneous resolution without treatment to the occurrence of a life threatening complication [1,2]. These include bleeding, perforation, and obstruction, of which perforation is the second most frequent one. Being older than 60 years, Helicobacter pylori (H. pylori) infection, smoking, use of non-steroidal anti-inflammatory drugs, and other lifestyle or comorbidity factors are incriminated risk factors for PUD perforation. It is a common cause of emergency admission that almost always needs surgical treatment [3]. The pattern of perforated PUD differs from one geographical area to another depending on the prevailing sociodemographic and environmental factors. In the developing world, the patient population tends to be younger males with late presentation, and there is a strong association with smoking. On the other hand, in the western countries, the patients are older, and there is a high prevalence of ulcerogenic drug usage [3,4]. The condition of the patient at presentation and delay in diagnosis and surgical treatment for perforated PUD has been associated with high morbidity and mortality [3,5,6]. Perforated PUD, especially duodenal perforation, is commonly treated with omental patch and medical therapy is used as long-term management to prevent recurrence of the disease [3,4,17]. Whereas definitive surgery like gastric resection is recommended for gastric perforation as it has a higher recurrence, although it is rarely practiced [3, 5, 17]. Though perforated peptic ulcer disease (PPUD) is one of the most common surgical emergencies at Jimma University Medical Center (JMC), there is little study done on the subject matter. In addition, there are a few studies done in the country [1,7]. This study will characterize the pattern and outcome of PUD management and identify factors associated with management outcomes. Therefore, it will help to describe the way PUD perforation presents and managed in JMC and compares the outcome of the management with varies studies from different countries. 2. Materials and Methods 2.1. Study design, setting and participants The study was conducted in Jimma University Medical Center, which is found in Jimma town, Ethiopia, located 350km southwest from capital city, Addis Ababa. It is the oldest Teaching and Referral hospital in the south western part of the country. Surgery department is one of major specialty available in the hospital. General surgery is a unit under the department of Surgery and they are the one who manage a patient presented with perforated PUD. Hospital-based descriptive cross sectional study with patients chart review was done from September 1, 2020 to August 30, 2025. All patients who were operated at JMC for PUD perforation during the study period were included in the study based on the inclusion criteria. Inclusion criteria was all patients who had been confirmed to have a PUD perforation intra-operatively. Exclusion criteria was those patients with incomplete chart and don’t have an intraoperative diagnosis of PUD perforation. 2.2. Data collection The medical record number (MRN) of all patients operated for PUD perforation in JUMC during study period were collected from the OR logbook, and charts were retrieved from the hospital medical store room. A structured questionnaire was developed in English using KoboToolbox and used for data collection. The data collection team comprised four well-trained general surgery residents. Data were extracted and transferred into SPSS version 30 for statistical analysis Data extracted included detail history of the patients including presenting symptoms, duration symptoms, previous history of PUD, alcohol history, cigarette smoking, chat chewing habit, and use of Non-steroidal anti-inflammatory drugs (NSAIDS). All relevant physical finding at admission, operative findings and treatment were also recorded. The outcome was defined as the consequences that will occur as a result of PPUD that can be either favorable (patients that are discharged improved) or unfavorable (those who develop complications or died postoperatively). 2.3. Sample size The sample size for the study was determined using single population proportion formula. n=({z_(a/2)} 2 p(⊢p))/d 2 . Where n = required sample size. Za/2 = level of significance of population at 95% confidence interval = 1.96. P = the proportion (P) outcome of PPUD in Adama hospital medical college is 14.2 ( 8 ) d = a 5% margin of error = 0.05. Using the above equation n = 187.2. Because of small number of cases operated for PUD perforation (N = 181), which is less 10,000 and initially calculated sample size (187.2) represented more than 5% of this population (n > 5% of N), the final sample size was determined using finite population correction formula. N f = n = [(_(n/(1 + n/N)))]. Where N is the number of patients operated for perforated PUD during the study period. Using above formula Nf = 92 Finally, after adding a 10% non-response rate, the final sample size for the study became 102. 2.4. Quality control Before data collection, pretest was conducted on 5% of the sample. The findings and observation obtained from the pretest was used to refine the checklist and improve the data collection process. To ensure data quality during the data collection period, the KoboToolbox form was programmed with validation rules such as range limits, skip logic, and mandatory fields to reduce entry errors and missing data. Data quality was also controlled through continuous supervision during data collection. All completed data collection forms were examined for completeness and consistency during data management, storage and analysis. 2.5. Statistical analysis Data were analyzed using IBM SPSS Statistics. The mean standard deviation (SD), median and ranges was determined for continuous variables whereas proportions and frequency tables was used to summarize categorical variables. Using bivariate and multivariate logistic regression, respectively, the pattern of relationship between the dependent and independent variables is discovered. Chi-square (c2) test will be used to test for the significance of association between the independent (predictor) and dependent (outcome) variables in the categorical variables. At P-value < 0.05, the relationship between the variables is deemed significant. The strength of the association between dependent and independent variables is expressed using adjusted odds ratio (AOR). 2.6. Ethical considerations Ethical approval was obtained from the institutional review board of Jimma University. Written informed consent of the patients was not included in the questionnaire since medical data were collected retrospectively and anonymity as well as confidentiality of the patients’ medical data were maintained throughout the study. We also obtained a letter of consent to conduct research from department of surgery and submit to medical record room to commence data collection. 3. Results Socio-demographic characteristics A total of 102 patients who had emergency laparotomies for perforated peptic ulcers during the study period were enrolled in the study. Twelve (11.8%) of them were female, and 90 (88.2%) were male. The ratio of men to women was 7.5: 1. The patients ranged in age from 15 to 75 years, with a mean age of 35.4 (SD ± 15.5) years. About 43 (42.2%) were from urban and 59(57.8%) from rural areas surrounding Jimma zone (Table 1 ). Table 1 Socio-demographic characteristic of patients with perforated peptic ulcer disease, at JMC, Ethiopia. Variables Category Frequency Percentage (%) Age =70yrs 3 2.9 Sex Male Female 90 12 88.2 11.8 Residents Urban Rural 43 59 42.2 57.8 Eighty one (79.4%) patients reported previous history of dyspepsia or a history of treatment for peptic ulcer disease. Nine individuals out of the total enrolled patients have a history of alcoholism, and 42(41.2) of patients have a history of chat chewing. On the other hand, none of the patients had surgery for a perforated PUD (Table 2 ). Table 2 Distribution of risk factors among patients with perforated Peptic ulcer disease, JMC, Ethiopia Risk factor variables Category Yes , N (%) No , N (%) Previous history of dyspepsia 81(79.4) 21(20.6) Alcohol consumption 9(8.8) 93(91.2) Smoking 8(7.8) 94(92.2) Chat chewing 42(41.2) 60(58.8) Use of NSAIDS 5(4.9) 97(95.1) H. Pylori positive 4(3.9) 2(1.9) Patient treated with PPI or H2 blocker 55(53.9) 47(46.1) Patient take eradication therapy 2(1.9) 100(98.1) Only (3.9%) of patients have the fifth level of American Society of Anesthesiologists (ASA) scores, whereas over two-thirds (72.2%) of patients have the second level (Fig. 1 ). The mean duration of symptoms was (41.78 ± 32.4) SD hours, with a range of 2 hours to 6 days. Of the patients, forty-three (42.2%) presented in within twenty-four hours of the onset of symptoms, and more than 57.8% presented in more than twenty-four hours later (Table 3 ). Most patients in the current study presented with generalized abdominal pain 88(86.3%), while epigastric pain was accounted by 14(13.7%) patients. Eight (7.8%) patients presented with un-recordable systolic blood pressure (SBP). Sixty-four (62.7%) patients had a pulse rate (PR) more than 100 beats per minute, and sixteen (15.7%) patients had a systolic blood pressure of less than 90 mmHg. Out of a total number of localized peritonitis, eight patients have abdominal tenderness over right lower quadrant and seven patients have epigastric tenderness. Regarding to laboratory findings, White blood cell (WBC) was normal (4000-10,000/mm3) in 50(49%) patients, 36(35.3%) of the patients had leukocytosis (WBC > 10,000 /mm3) and about twenty (19.6%) patients had deranged renal function test (RFT) (Table 3 ). Table 3 Clinical and laboratory finding of perforated peptic ulcer disease patients, at JMC, Ethiopia Variables Category Frequency Percentage (%) Duration of symptoms 24 hours 59 57.8 Presenting compliant Generalized abdominal pain 88 86.3 Epigastric pain 14 13.7 Abdominal finding generalized peritonitis 85 83.3 Localized peritonitis 15 14.7 no sign of peritonitis 2 2 SBP Not recordable 8 7.8 =90 mmhg 78 76.5 PR =100 64 62.7 Lab finding WBC at presentation Leucopenia 16 15.7 Normal 50 49 Leukocytosis 36 35.3 RFT at presentation Normal range 46 45.1 Abnormal 20 19.6 Not done 36 35.3 Intraoperative and procedure done Eighty-one patients (79.4%) had perforations on the anterior first part of the duodenum, while the other twenty patients (19.6%) had perforations on the pre-pyloric stomach. Size of perforation ranges from 0.1cm to 10cm with mean size of perforation (0.5 ± 0.82 SD) cm. Seventy seven (75.5%) of the perforations were between 0.5cm and 1cm and 15 (14.7%) were > 1 cm. Approximately two-third of patients (64%) has an amount of peritoneal fluid greater than one litter (Table 4 ). Table 4 Intra-operative finding of patients with perforated peptic ulcer disease, at JMC, Ethiopia. Variable Category Frequency Percent % Location of perforation Duodenum 81 79.4 Pre-pyloric/gastric 20 19.6 Sealed 1 1 Size of perforation 1cm 15 14.7 Peritoneal contamination 2L 20 19.6 For the majority, 86(84.3%) of the patients repair was done with omental pedicle alone. Other procedures, including simple repair, falciform ligament patch, and combinations with gastrojejunostomy, jejunostomy, or vagotomy, were performed in only a small number of patients (Table 5 ). Sub hepatic drain was put for 20(19.6%) patients, pelvic drian for two patients, lesser sac posterior to the stomach for one patients, right paracolic gutter for one patients and right upper quadrant drain for one patient. Table 5 Repairing mechanisms (procedures) for perforated Peptic ulcer disease patients, at JMC, Ethiopia. Types of procedure Frequency Percent % Pedicle omental patch 86 84.3 Simple repair 2 2 Falcifarem ligament patch 3 2.9 Omental patch + GJ+JF 2 2 Pedicle omental patch + Retrocolic GJ 2 2 Pedicled omental patch + GJ+ pyloric exclusion 4 3.9 Pedicled omental patch + GJ +trunkal vagatomy 2 2 Subtotal gastrectomy + GJ +JJ +duodenal stamp 1 1 Biopsy taken 17 16.7 Note;-GJ= gastro-jejunostomy, JF= jejunostomy feeding, Postoperative outcome Thirty seven (36.3) patients were post-operative complications recorded. Of these, superficial and deep surgical site infection 8(21.6%), intra- abdominal collections 6(16.2%) and hospital acquired infection (HAI) 4 (10.8%) were the commonest. Whereas, the others were postoperative such as wound dehiscence were the least complications (Table 6 ). Table 6 post-operative complication of patients with perforated peptic ulcer disease, at Jimma University Medical Center, Ethiopia Type complication Frequency Percent % Surgical site infection 8 21.6 Intra-abdominal collection without leak 6 16.2 Patch failure 2 5.4 Gastric perforation + HAI 2 5.4 Patch failure +pneumonia 2 5.4 Wound dehiscence 2 5.4 Hospital acquired infection 4 10.8 Refractory septic shock 3 8.1 Delay awakening 4 10.8 Electrolyte imbalance 2 5.4 Upper GI bleeding 1 2.7 AKI (acute kidney injury) 1 2.7 Thirteen 13/102 (12.7%) patients were undergone re-laparotomy of the procedure. Seven (53.8%) patients re-operated for post-operative intraoperative collection without patch failure, four (30.7%) patients due to patch failure, one patient due to Gastric perforation and one patient due to development of gangrene on distal ileum. Three patient undergone second re-laparotomy (2.9%) and one patient undergo 3rd re-laparotomy (0.98%) while the findings were leak from the perforation site in all of them. Fourteen (13.7%) patient were admitted to ICU after procedure and nine of the patients (64%) were died in the unit, whereas the rest of five patients (36%) transferred to surgical ward. Overall, eight seven (85.3%) patients were discharged improved and fifteen (14.7%) died (Fig. 4 ). Thirty-nine (44.8%) patients were discharged within 7 days (Fig. 3 ). However, only two patients were re-admitted to hospital. Factors associated with postoperative morbidity and mortality of patients with perforated peptic ulcer disease After running a bivariate analysis, variables with P-values of less than or equal to 0.25 were selected as a candidate variable for the final model. Accordingly, variables age, address, previous history of PUD, duration of presentation, history of hypotension, perforation size, fluid contamination status, and Procedure done/repaired were found to be a candidate variable for the postoperative morbidity and mortality in this particular study. After controlling for the potential confounders at the multivariable logistic regression model, variables such as duration at presentation(( P -value = 0.021 , AOR = 3.2 , CI = (1.06, 9.59) , previous history of PUD (( P -value = 0.021 , AOR = 8.4 , CI = (1.38,11.5) , history of hypotension((P-values = 0.017, AOR = 4.5 , CI = (1.31,15.7 ) and Procedure done/repaired (( P -value = 0 .012, AOR = 6.2 , CI = (1.48,15.9) , were found to be statistically significant factors that were associated for postoperative morbidity/ complication among patients with perforated PUD in JMC (Table 7 ). Whereas, variables like Duration at presentation(( P -value = 0 .038, AOR = 5.5 , CI = (1.20,25.84) ,, age of patients((P-value = 0 .016, AOR = 3 , CI = (1.60,6.62) ,, history of hypotension(( P -value = 0 .006, AOR = 6.4 , CI = (1.79,11.98) , and Perforation size(( P -value = 0 .030, AOR = 6 , CI = (1.18,29.6) , were found to be statistically significant factors that were associated for postoperative mortality of patients with perforated PUD(Table 8 ). Table 7 Multivariable logistic regression analysis for factors associated with postoperative morbidity of PPUD patients in JMC Variables Category Complication after surgery COR (95% CI) P-value AOR (95% CI) Yes(%) No(%) Age =60 5(62.5) 3(37.5) 6.1(1.16,31.9) 4.2(0.85,19.7) Address Urban 11(25.6) 32(74.4) 1 .058 1 Rural 26(44 33(56) 2.3(0.97,5.39) 2.2(0.76,6.43) History of PUD No 3(14.3) 18(85.7) 1 .027 1 Yes 34(42) 47(58) 4.3(1.18,15.9) 8.4(1.38,11.5)* Duration at presentation =24hrs 17(56.7) 13(43.3) 3.4(1.4,8.25) 3.2(1.06,9.59)* Hypotension No 20(20.4) 78(79.6) .000 1 Yes 17(41.5) 24(58.5) 7(2.54,19.4) 4.5(1.31,15.7)* Perforation size = 1cm 10(71.4) 4(28.6) 5.6(1.62,19.6) 2.2(0.46,11.03) Fluid contamination 1 liter 18(48.6) 19(51.4) 3.1(1.32,7.5) 1.9(0.62,6.23) Procedure done/repaired Pedicle omental 26(30.2) 60(69.8) 1 .006 1 Others 11(68.7) 5(31.3) 5(1.60. 16.08) 6.2(1.48,15.9)* * Indicates P-value < 0.05 Table 8 Multivariable logistic regression analysis for factors associated with postoperative mortality of PPUD patients in JMC Variables Category Outcome of patients COR (95% CI) P-value AOR (95% CI) Death (%) Improved(%) Age =60 3(37.5) 5(62.5) 4.1(0.86,19.4) .015 3(1.60,6.62)* Address Urban 4(9.3) 39(90.7) 1 Rural 11(18.7) 48(81.3) 2.2(0.66,7.56) .196 1.5(0.30,7.46) History of PUD No 1(4.7) 20(95.3) Yes 14(17.3) 67(82.7) 4.2(0.51,33.7) .180 12.3(0.52,29.5) Duration at presentation =24hrs 9(30) 21(70) 4.7(1.5,14.8) .008 5.5(1.20,25.84)* Hypotension No 5(6.4) 73(93.6) 1 Yes 10(41.6) 14(58.4) 10.4(3.09,35.2 .000 6.4(1.79,11.98)* Perforation size = 1cm 6(42.8) 8(57.2) 6.5(1.86,23.28) .003 5.9(1.18,29.6)* Procedure done/repaired Pedicle omental 10(11.6) 76(88.4) 1 1 Others 5(31.2) 11(68.8) 3.4(0.99,12.0) .051 3.1(0.531,18.4) Fluid contamination 1 liter 10(30.3) 23(69.7) 5.5(1.72,18.01) .004 3.1(0.66,15.4) * Indicates P-value < 0.05 4. Discussion The predominance of male patients in this study align with previous report from Ethiopia and East Africa. In this region, perforated peptic ulcer disease (PPUD) affects men far more than women. Studies from hospitals in Addis Ababa and Adama Hospital Medical College reported male-to-female ratios of 6–7:1 and 9:1 respectively and data from Jigjiga and Northwestern Tanzania similarly show male predominance ( 1 , 7 – 9 , 13 ). This pattern is likely attributable to greater exposure among men in this region to known risk factors such as smoking, alcohol consumption, and khat chewing ( 2 , 5 , 8 ). The average age of patients in our study was 35.4 years. This finding is also observed in regional trends which showed PPUD tends to affect younger adults in low-resource settings ( 1 , 7 , 8 ). However, studies from high-income countries report a higher mean age, often in the 50–60-year range ( 3 , 4 ). This difference may indicate variation in Helicobacter pylori prevalence, dietary patterns, and access to healthcare that may contributed to earlier disease onset in developing regions ( 2 , 3 , 5 ). In this study, 79.4% of patients had a prior history of dyspepsia which shows that chronic peptic symptom often precede perforation. Similar findings were reported in Ethiopia: 75% at Tikur Anbessa affiliated hospitals ( 1 ) and 80% at Adama Hospital ( 8 ), as well as 56% in south Nigeria ( 12 ). In contrast, large Western population studies have documented significant declines in the incidence of perforated peptic ulcer after widespread use of proton pump inhibitors that shows a reduced chronic ulcer disease burden ( 3 , 4 , 22 , 23 ). Only 3.9% of patients were documented as H. pylori positive. However, for the remaining their status were unknown, reflecting incomplete testing. Similar patterns are reported regionally: H. pylori testing was limited at Addis Ababa hospitals, and Jigjiga hospitals ( 7 , 9 , 14 ). In contrast, Western studies report routine H. pylori screening and eradication, which significantly reduced its role in perforation ( 3 , 4 , 22 , 23 ). This highlights the underdiagnosis of H. pylori in African settings may indirectly contributed to ulcer complications ( 1 , 11 ). However, in our study, only 1.9% had received H. pylori eradication therapy and only 54% treated with PPI or H2 blocker. This emphasizes a major gap in evidence-based management compared with Western standards ( 3 , 4 , 22 ). In this study, 8.8% of patients reported alcohol use and 7.8% reported smoking. These rates are lower than those reported in other Ethiopian studies, such as 47 and 35% at tertiary hospital in Addis Ababa, respectively ( 7 ) and 34 and 42% at Adama Hospital, respectively ( 8 ). They are also lower than Western populations where smoking and alcohol consumption are more prevalent. For example, a Croatian surgical cohort reported smoking in 33.6% and alcohol use in 22.1% of patients ( 10 ). The lower rate in this study may be due to under-reporting, cultural factors, or genuinely lower exposure ( 1 , 7 , 9 ). Khat chewing was observed in 41.2% of patients. This is higher than 9 and 18% reported from Addis Ababa hospitals ( 1 , 7 ) and comparable to 45% at Adama Hospital and 56.6% at Jijjiga hospitals ( 8 ). This regional habit is rarely reported in Western literature. Khat may contribute to mucosal injury through increased gastric acid secretion and delayed gastric emptying. This highlights the importance of local behavioral factors in East African PUD patients ( 1 , 7 – 9 ). In this study, 4.9% of patients reported NSAID use. This is comparable to reports of 2% at Addis Ababa Hospital ( 1 , 7 ) and significantly lower than 36.8% at Adama Hospital ( 8 ). On the other hand, studies from high-income countries report NSAID as a major risk factor, particularly following the widespread use of proton pump inhibitors ( 3 , 4 , 22 ). In this study, the mean duration of symptoms prior to presentation was 42 hours whereas 57.8% of patients present more than 24 hours after symptom onset. Regional studies report similar delays: 55% at Tikur Anbessa affiliated hospitals ( 1 ), 71% at Adama Hospital ( 8 ), and 71% in Northwestern Tanzania ( 13 ). Such delays are common in low-resource settings due to geographic barriers, limited health literacy, reliance on traditional remedies, and possible under-recognition of perforation by initial healthcare providers ( 1 , 7 , 8 ). However, patients in high-income countries typically present within hours of symptoms onset as result of widespread access to emergency services and diagnostic imaging. This allowed earlier surgical intervention and improved outcomes ( 3 , 4 , 22 ). In this study, the majority of perforations (79.4%) involved the anterior first part of the duodenum. This is also consistent with both regional and global trends ( 7 , 8 , 13 , 14 ). They reported duodenal involvement of 94% at Tikur Anbessa affliated hospitals ( 1 ) and 81% at Adama Hospital ( 8 ), as well as 93% in Northwestern Tanzania ( 13 ). Western cohorts often show a relative higher proportion of gastric (pre-pyloric) perforations frequently associated with NSAID and aspirin use among elderly patients ( 3 , 5 , 15 , 22 ). On the other hand, the predominance of duodenal perforation in this region likely reflects a strong link to H. pylori infection and regional dietary or environmental factors, which warrant further investigation ( 3 , 13 – 15 , 18 ). The mean perforation size in this study was 0.5 ± 0.82 cm. Most of the perforations (75.5%) measures 0.5–1 cm and 14.7% exceeding 1 cm. This aligns with regional data, where small perforations predominate: Tikur Anbesa affiliated hospitals (81%) ( 1 ), tertiary hospital of Addis Ababa (90%) ( 7 ), Jigjiga (88%) ( 9 ), and Nigerian center (49%) ( 11 ). These small perforations are typically amenable to simple omental patch repair ( 3 , 17 , 20 ). Meanwhile, Western settings report larger perforations often related to NSAID-induced gastric ulcers or malignancy ( 3 , 5 , 15 , 22 ). Such perforation requires more complex interventions such as partial gastrectomy ( 3 , 17 , 20 ). Regarding peritoneal contamination, 64% of patients had more than one liter of peritoneal pus. This shows delayed presentation and advanced peritonitis. ( 3 , 6 , 17 ) Although regional studies rarely quantify contamination volume, reports from Addis Ababa, Adama, Jigjiga, and other sub-Saharan centers similarly describe gross peritoneal contamination at surgery ( 7 , 8 , 9 , 13 , 14 ). By contrast, Western patients present earlier, with lower contamination volumes and improved postoperative outcomes due to timely access to emergency care and imaging ( 3 , 5 , 15 , 17 ). In this study, pedicled omental patch repair was the most performed procedure. It accounted for 84.3% of cases. This reflects the simplicity, and effectiveness of the technique in emergency settings ( 3 , 17 , 20 ). Regional and international studies report similar trends: tertiary hospital of Addis Ababa, Ethiopia (92.6%) ( 7 ), Adama Hospital (89%) ( 8 ), Jigjiga (98%) ( 9 ), Northwestern Tanzania (83%) ( 13 ), and Nigerian centers (77 & 89%) ( 11 , 12 ) all show a predominance of omental patch closure for small duodenal perforations. The procedure provides a rapid and safe solution for patients often presenting late or in poor general condition which is a common scenario in low-resource settings ( 3 , 15 , 17 , 20 ). A smaller proportion of patients underwent alternative or adjunctive procedures. This included simple repair (2%), falciform ligament patch (2.9%), and combined procedures such as omental patch with gastrojejunostomy (GJ), pyloric exclusion, or truncal vagotomy. These interventions were reserved for large ulcers or those with failed patch ( 3 , 17 , 20 ). Similarly, regional studies report limited use of these alternative or complex procedures, including Tikur Anbessa affiliated hospitals, Jigjiga, and Northwestern Tanzania ( 7 , 9 , 13 ). In our study, one patient (1%) required a subtotal gastrectomy with GJ and jejunojejunostomy (JJ) as definitive ulcer surgery. In Western practice, the management of perforated PUD has evolved substantially. Effective medical therapy has greatly reduced the need for definitive anti-ulcer procedures, especially for duodenal perforations ( 3 , 4 , 22 ). Laparoscopic omental patch repair is now considered the gold standard in many high-income centers for hemodynamically stable patients with small perforations. It offers reduced postoperative pain, faster recovery, and shorter hospital stay ( 17 , 20 ). On the other hand, in regional settings such as Ethiopia and neighboring countries, laparoscopic surgery remains limited due to resource constraints, and insufficient expertise. This makes open pedicled omental patch repair the most practical and effective option in regional setting ( 7 , 13 , 14 ). The use of falciform ligament patch repair (2.9%) in this study is noteworthy. While regional cohorts rarely report this technique, it demonstrates a practical alternative when the greater omentum is unavailable ( 1 , 7 – 9 , 13 , 25 ). Evidence from Australia practice supports its safety and efficacy ( 25 ). However, in Western practice, such techniques are rarely needed due to earlier presentation and timely intervention ( 3 , 17 , 22 ). Postoperative complications occurred in 36.3% of patients. This is higher than rates reported in high-income countries where morbidity following PPUD repair typically ranges from 5–20% due to advanced perioperative care and laparoscopic approaches ( 3 , 4 , 22 , 25 ). Regional studies report comparable complication rates: Ethiopia (Addis Ababa tertiary hospitals 23% [7], Adama 28% [8], Jigjiga 29% [9]), Northwestern Tanzania 30% ( 13 ), and Nigeria greater than and equal to 20% ( 11 , 12 ). This indicates that outcomes in this study are consistent with the regional context. The elevated complication rate may result from delayed presentation, limited ICU capacity, and variability in perioperative care. While omental patch repair is effective, its success depends on timely intervention and adequate resuscitation—factors often compromised in emergency settings with constrained resources ( 1 , 7 , 8 , 9 , 13 – 16 ). In this study, several factors independently predicted postoperative morbidity and mortality. Delayed presentation independently predicted postoperative morbidity (AOR = 3.2) and mortality (AOR = 5.5), highlighting the central role of timely care in low-resource settings. This is consistent with an Ethiopian meta-analysis identifying delayed presentation and preoperative hypotension as major determinants of unfavorable outcomes ( 18 ). In addition, multicenter data from Jigjiga associated late presentation and shock to complications and death ( 9 ). Although some regional studies lack adjusted analyses, they uniformly report poorer outcomes with delayed presentation ( 13 , 14 , 19 ). In contrast, earlier presentation and lower mortality in high-income settings reflect rapid referral and prompt surgery ( 3 , 4 , 22 ). A prior history of PUD also independently predicted postoperative morbidity in this study (AOR = 8.4). This suggests that chronic ulceration may predispose patients to more severe perforations or delayed recognition of symptoms. Although most regional studies report previous ulcer symptoms descriptively, they consistently show that 40–80% of patients had antecedent dyspepsia or known PUD ( 8 , 9 , 14 ). A similar patterns were also seen across other African cohorts ( 11 , 12 ). In contrast, lower recurrence and complication rates in high-income settings reflect routine H. pylori testing and eradication and widespread use of proton pump inhibitor. These interventions have limited ulcer persistence and progression to perforation ( 2 , 17 , 22 ). Hypotension at presentation was strong predictor of both postoperative morbidity (AOR = 4.5) and mortality (AOR = 6.4) in our study. This is consistent with its role as marker of systemic compromise and sepsis ( 3 , 17 ). This finding is similar with the Ethiopian meta-analysis, which identified preoperative hypotension as a major determinant of unfavorable outcomes after perforated PUD ( 18 ). Regional studies from Ethiopia and Tanzania report that 20–30% of patients present in shock and similarly associated strongly with postoperative complications and death ( 1 , 7 , 9 , 13 ). In contrast, lower morbidity and mortality in well-resourced settings are attributed to prompt resuscitation, vasopressor support, and early source control, which mitigate the physiologic impact of shock ( 3 , 17 ). Surgical procedure type independently predicted postoperative morbidity in this study (AOR = 6.2). This is likely reflects ulcer severity and operative approach. A higher complication rates are observed in patients requiring more extensive procedures for large or complex perforations ( 7 , 11 – 13 ). In contrast, selected patients in well-resourced settings increasingly undergo laparoscopic patch repair that has been associated with lower morbidity and shorter hospital stay ( 3 , 17 , 20 ). However, open repair remains the standard in most African centers due to limited resources ( 17 , 19 – 21 ). Age and perforation size independently predicted mortality in this study. These findings are consistent with global evidence that elderly patients and those with larger defects face higher perioperative risk ( 3 , 4 , 6 , 24 ). The Ethiopian meta-analysis identified advanced age as a major determinant of poor outcomes ( 18 ). In addition, regional cohorts from Ethiopia, Nigeria, Tanzania, and Liberia report similar associations ( 9 , 11 – 13 , 19 ). However, the magnitude of association in our study (AOR = 3 for age and AOR = 6 for perforation size ), suggests that that these factors may be amplified by delays in care and limited perioperative monitoring. In high-income settings, early diagnosis, optimized resuscitation, and intensive monitoring mitigate these risks ( 3 , 4 , 5 , 20 ). 5. Conclusions In this study, perforated peptic ulcer disease predominantly affected young male patients and the majority of perforations occurred in the first part of the anterior duodenum. Most patients presented after 24 hours of symptom onset, resulting in extensive peritoneal contamination and high postoperative complication rate. The pedicled omental patch was the most frequently performed procedure and provided favorable outcomes in most cases. Delayed presentation, advanced age, large perforation size, hypotension at admission, and type of surgical procedure were significant predictors of morbidity and mortality. These findings underscore the continued burden of perforated peptic ulcer disease in our setting. Therefore, improving outcomes in perforated peptic ulcer disease requires strengthening perioperative care. This include standardizing protocols, expanding critical care capacity, and gradual adoption of laparoscopic repair. In addition, community education on early symptoms recognition and modification of risk behaviors are also important to promote timely care. At the system level, integration of Helicobacter pylori screening into primary care and development of national clinical guidelines are crucial. Furthermore, improved referral and enhanced diagnostic capacity are essential. Finally, sustained investment in surgical infrastructure and workforce development are necessary to reduce disease burden and improve surgical outcomes. Abbreviations • ASA American Society of Anesthesiologists • AKI Acute Kidey injury • AOR Adjusted Odds Ratio • CI Confidence Interval • COR Crude Odds Ratio • GJ Gastrojejunostomy • HAI Hospital acquired infection • JF Jejunal Feeding • JJ Jejunojejunostomy • JMC Jimma University Medical Center • MRN Medical Record Number • NSAID Non–Steroidal Anti–Inflammatory Drug • PPUD Perforated Peptic Ulcer Disease • PR Pulse Rate • PUD Peptic Ulcer Disease • RFT Renal Function Test • SBP Systolic Blood Pressure • SD Standard Deviation • WBC White Blood Cell (count) Declarations Ethical approval and consent to participate Ethical approval was obtained from the Institutional Review Board (IRB) of Jimma University Institute of Health , Ethiopia (Ethical clearance number: JUIH/IRB/0471/25). The requirement for informed consent was not required by the IRB due to the retrospective nature of the study . Patient data were anonymized and kept confidential. Consent for publication Not applicable. No individual patient data are presented that require consent for publication. Availability of data and materials The dataset(s) supporting the conclusions of this article are available from the corresponding author on reasonable request. Competing interests The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper. Funding This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. Authors' contributions Dr. Gutu Ganati Tola ( Corresponding author ) : conceived and designed the study, developed the methodology, and defined the research objectives; verified, and managed patient data, prepared it for analysis, and discussed the findings; drafted the manuscript, integrated relevant literature, critically revised it for clarity and scientific rigor, coordinated co-author input, and approved the final version as the first and corresponding author. Temesgen Temitim Demis : Performed the statistical analysis, applied appropriate tests, interpreted the results, and contributed to data visualization. Assisted in the interpretation of findings for the manuscript and reviewed relevant sections to ensure accuracy and clarity in reporting the results. Dr. Zemzem Mohammed Selamo : Participated in data collection from patient records, ensured completeness and accuracy of the dataset, and assisted in data management. Dr. Seifu Alemu Taye : participated in the study design, methodology development, and the research objectives definition; reviewed and proofread the manuscript; provided feedback on clarity, formatting, and overall readability. All authors reviewed the manuscript and approved the final version for submission. Acknowledgements Not applicable. Clinical trial number Not applicable. References Bupicha JA, Gebresellassie HW, Alemayehu A. Pattern and outcome of perforated peptic ulcer disease patient in four teaching hospitals in Addis Ababa, Ethiopia: a prospective cohort multicenter study. BMC Surg. 2020;20:135. 10.1186/s12893-020-00796-7 . Hao W, Zheng C, Wang Z, Ma H. Global burden and risk factors of peptic ulcer disease between 1990 and 2021: an analysis from the global burden of disease study 2021. PLoS ONE. 2025;20(7):e0325821. 10.1371/journal.pone.0325821 . Søreide K, Thorsen K, Harrison EM, Bingener J, Møller MH, Ohene-Yeboah M, et al. Perforated peptic ulcer. Lancet. 2015;386:1288–98. Boey J, Choi SK, Poon A, Alagaratnam TT. Risk stratification in perforated duodenal ulcers: a prospective validation of predictive factors. Ann Surg. 1987;205(1):22–6. 10.1097/00000658-198701000-00005 . Thorsen K, Søreide JA, Kvaløy JT, Glomsaker T, Søreide K. Epidemiology of perforated peptic ulcer: age- and gender-adjusted analysis of incidence and mortality. World J Gastroenterol. 2013;19(3):347–54. Sivaram P, Sreekumar A. Preoperative factors influencing mortality and morbidity in peptic ulcer perforation. Eur J Trauma Emerg Surg. 2018;44(2):251–7. 10.1007/s00068-017-0777-7 . Teshome H, Birega M, Taddese M. Perforated peptic ulcer disease in a tertiary hospital, Addis Ababa, Ethiopia: five year retrospective study. Ethiop J Health Sci. 2020;30(3):363. 10.4314/ejhs.v30i3.7 . Bejiga G, Negasa T, Abebe A. Treatment outcome of perforated peptic ulcer disease among surgically treated patients: a cross-sectional study in Adama Hospital Medical College, Adama, Ethiopia. Int J Surg Open. 2022. 10.1016/j.ijso.2022.100564 . Burale A, Beyene B, Ahmed M, Hussen A, Hassan MS, Hassan SM, et al. Magnitude, outcome, and predictors of mortality in perforated peptic ulcer disease: a retrospective study in Jigjiga town, Ethiopia. World J Emerg Surg. 2025;20(1):56. 10.1186/s13017-025-00628-0 . Krajnović I, Pogorelić Z, Perić I, Ćavar M, Borić M. Does Seasonality Affect Peptic Ulcer Perforation? A Single-Center Retrospective Study. Med (Kaunas). 2025;61(6):945. 10.3390/medicina61060945 . PMID: 40572634; PMCID: PMC12195547. Agada OH, Grimah V, Godwin JT, Adokwe LB. A five-year review of perforated peptic ulcer disease in a tertiary hospital in Lafia, North-Central Nigeria. Orient J Med. 2025;37(1–2):81–8. 10.5281/zenodo.15448408 . Dodiyi-Manuel A, Wichendu PN, Enebeli VC. Presentation and management of perforated peptic ulcer disease in a tertiary centre in South South Nigeria. J West Afr Coll Surg. 2015;5(3):36–48. Chalya PL, Mabula JB, Koy M, Mchembe MD, Jaka HM, Kabangila R, et al. Clinical profile and outcome of surgical treatment of perforated peptic ulcers in northwestern Tanzania: a tertiary hospital experience. World J Emerg Surg. 2011;6:31. 10.1186/1749-7922-6-31 . Bekele A, Zemenfes D, Kassa S, Deneke A, Taye M, Wondimu S. Patterns and seasonal variations of perforated peptic ulcer disease: experience from Ethiopia. Ann Afr Surg. 2017;14(2):86–91. 10.4314/aas.v14i2.7 . Peiffer S, Pelton M, Keeney L, Kwon EG, Ofosu-Okromah R, Acharya Y, et al. Risk factors of perioperative mortality from complicated peptic ulcer disease in Africa: systematic review and meta-analysis. BMJ Open Gastroenterol. 2020;7(1):e000350. 10.1136/bmjgast-2019-000350 . An SJ, Davis D, Kayange L, Gallaher J, Charles A. Predictors of mortality for perforated peptic ulcer disease in Malawi. Am J Surg. 2023;225(6):1081–5. 10.1016/j.amjsurg.2022.11.029 . Tarasconi A, et al. Perforated and bleeding peptic ulcer: WSES guidelines. World J Emerg Surg. 2020;15(1):3. 10.1186/s13017-019-0283-9 . Endeshaw D, Adal O, Tareke AA, et al. Unfavorable outcomes and their predictors in patients treated for perforated peptic ulcer disease in Ethiopia: systematic review and meta-analysis. BMC Gastroenterol. 2025;25:248. 10.1186/s12876-025-03865-4 . Moses JF, et al. Surgical outcomes for perforated peptic ulcer: a prospective case series at an academic hospital in Monrovia, Liberia. Afr J Emerg Med. 2015;5(2):60–5. 10.1016/j.afjem.2014.11.002 . Gavriilidis P, Schena CA, Di Saverio S, et al. Alternative treatments to treat perforated peptic ulcer: a systematic review and network meta-analysis of randomized controlled trials. World J Emerg Surg. 2025;20:31. 10.1186/s13017-025-00599-2 . Muleta MB et al. Pattern of general surgical and urologic admissions at St. Paul’s Hospital Millennium Medical College. Ethiop Med J. 2019;57(1). Hermansson M, Ekedahl A, Ranstam J, et al. Decreasing incidence of peptic ulcer complications after the introduction of the proton pump inhibitors, a study of the Swedish population from 1974–2002. BMC Gastroenterol. 2009;9:25. https://doi.org/10.1186/1471-230X-9-25 . Xie X, Ren K, Zhou Z, Dang C, Zhang H. The global, regional and national burden of peptic ulcer disease from 1990 to 2019: a population-based study. BMC Gastroenterol. 2022;22(1):58. 10.1186/s12876-022-02130-2 . Monica OMA, Popescu A, Ionescu D, Georgescu C, Stanescu R, et al. Emergency management of perforated gastro-duodenal ulcers: surgical strategies, outcomes, and prognostic determinants in a tertiary Eastern European center. Med (Kaunas). 2025;61(11):2029. 10.3390/medicina61112029 . Seenarain V, Wilson T, Fletcher DR, Foster AJ. Retrospective comparison of outcomes of patients undergoing omental patch versus falciform patch repair of perforated peptic ulcers. ANZ J Surg. 2024;94(3):371–4. 10.1111/ans.18728 . Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-8747676","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":602434276,"identity":"8e32d4eb-d9e8-4e39-8ca3-7080a7ec9dc9","order_by":0,"name":"Gutu Ganati Tola","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA8ElEQVRIiWNgGAWjYHADxsYHEiD6AEGVzFCajbHZAK4Fvza4FgY2sA6CWuQj8o9JMPyyy+Of39xWYdnGIMd3I4Hx8Qc8WgxvJLNJMPYlF0scY2y7IdnGYCx5I4HZAJ8thjNAWnqYExugWhI33EhgkyBCS33ifKCWAqCWeqAW9h94/SIB1MLw43DiBqAWBqCWBAOgLXi9b8Dz2NgiseF44sZjic0SEuckDGeeedgscQafLe2JD298+FOdOO/w8YefJcps5PmOJx/8UIHPFpATEtsgHGYJBlDUMDbg0QC0BSz9B8JhxBcdo2AUjIJRMHIBANUtUEw+0Iz+AAAAAElFTkSuQmCC","orcid":"","institution":"Jimma University","correspondingAuthor":true,"prefix":"","firstName":"Gutu","middleName":"Ganati","lastName":"Tola","suffix":""},{"id":602434278,"identity":"21e9625a-7f19-4f49-8cf0-7d097f307c62","order_by":1,"name":"Temesgen Temitim Demis","email":"","orcid":"","institution":"Jimma University","correspondingAuthor":false,"prefix":"","firstName":"Temesgen","middleName":"Temitim","lastName":"Demis","suffix":""},{"id":602434280,"identity":"90bf22d0-ba23-4d41-afe0-619d9620d946","order_by":2,"name":"Zemzem Mohammed Selamo","email":"","orcid":"","institution":"Jimma University","correspondingAuthor":false,"prefix":"","firstName":"Zemzem","middleName":"Mohammed","lastName":"Selamo","suffix":""},{"id":602434281,"identity":"c5b37860-6943-4b86-8d73-c5111c0d2066","order_by":3,"name":"Seifu Alemu Taye","email":"","orcid":"","institution":"Jimma University","correspondingAuthor":false,"prefix":"","firstName":"Seifu","middleName":"Alemu","lastName":"Taye","suffix":""}],"badges":[],"createdAt":"2026-01-31 07:53:16","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-8747676/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-8747676/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":104415546,"identity":"f4d9ee00-5430-4fbb-9464-9b1440aa528f","added_by":"auto","created_at":"2026-03-11 13:11:08","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":36053,"visible":true,"origin":"","legend":"\u003cp\u003eASA score level of patients with perforated Peptic ulcer disease, at JMC, Ethiopia\u003c/p\u003e","description":"","filename":"1.jpg","url":"https://assets-eu.researchsquare.com/files/rs-8747676/v1/2722dd24fe6bb97e6dd28b4a.jpg"},{"id":104412463,"identity":"bfbe30fe-6d43-46ad-92c0-fa2f0e09ee5d","added_by":"auto","created_at":"2026-03-11 12:59:41","extension":"jpg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":58601,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eFigure 3:-\u003c/strong\u003eDuration of hospital stay of patients with perforated peptic ulcer disease, at JMC, Ethiopia\u003c/p\u003e","description":"","filename":"2.jpg","url":"https://assets-eu.researchsquare.com/files/rs-8747676/v1/c948ad39e98a90db0479c569.jpg"},{"id":104412027,"identity":"e290a8ad-1637-44e1-8834-7371469bcb12","added_by":"auto","created_at":"2026-03-11 12:58:32","extension":"jpg","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":34604,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eFigure 4:-\u003c/strong\u003eOutcome of patients with perforated peptic ulcer disease, at JMC, Ethiopia\u003c/p\u003e","description":"","filename":"3.jpg","url":"https://assets-eu.researchsquare.com/files/rs-8747676/v1/4b2e8a81810983fbae4b5448.jpg"},{"id":109336639,"identity":"568212a2-adcb-4f61-9c04-d28eb88f325d","added_by":"auto","created_at":"2026-05-15 17:24:34","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":605719,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8747676/v1/6e9efffe-8835-4932-9d9b-087b2cb2ecb1.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Determinants of morbidity and mortality in perforated peptic ulcer disease: A retrospective study at Jimma University Medical Center, Ethiopia","fulltext":[{"header":"1. Introduction","content":"\u003cp\u003ePeptic ulcer disease (PUD) refers to ulcers of the stomach and duodenum. It is the result of an imbalance of acid-pepsin secretion and mucosal defenses that protect from acid digestion. It is a common disease and a global public health concern. The natural history of peptic ulcer disease ranges from a spontaneous resolution without treatment to the occurrence of a life threatening complication [1,2]. These include bleeding, perforation, and obstruction, of which perforation is the second most frequent one. Being older than 60 years, Helicobacter pylori (H. pylori) infection, smoking, use of non-steroidal anti-inflammatory drugs, and other lifestyle or comorbidity factors are incriminated risk factors for PUD perforation. It is a common cause of emergency admission that almost always needs surgical treatment [3]. The pattern of perforated PUD differs from one geographical area to another depending on the prevailing sociodemographic and environmental factors. In the developing world, the patient population tends to be younger males with late presentation, and there is a strong association with smoking. On the other hand, in the western countries, the patients are older, and there is a high prevalence of ulcerogenic drug usage [3,4].\u003c/p\u003e \u003cp\u003eThe condition of the patient at presentation and delay in diagnosis and surgical treatment for perforated PUD has been associated with high morbidity and mortality [3,5,6]. Perforated PUD, especially duodenal perforation, is commonly treated with omental patch and medical therapy is used as long-term management to prevent recurrence of the disease [3,4,17]. Whereas definitive surgery like gastric resection is recommended for gastric perforation as it has a higher recurrence, although it is rarely practiced [3, 5, 17].\u003c/p\u003e \u003cp\u003eThough perforated peptic ulcer disease (PPUD) is one of the most common surgical emergencies at Jimma University Medical Center (JMC), there is little study done on the subject matter. In addition, there are a few studies done in the country [1,7]. This study will characterize the pattern and outcome of PUD management and identify factors associated with management outcomes. Therefore, it will help to describe the way PUD perforation presents and managed in JMC and compares the outcome of the management with varies studies from different countries.\u003c/p\u003e"},{"header":"2. Materials and Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003e2.1. Study design, setting and participants\u003c/h2\u003e \u003cp\u003eThe study was conducted in Jimma University Medical Center, which is found in Jimma town, Ethiopia, located 350km southwest from capital city, Addis Ababa. It is the oldest Teaching and Referral hospital in the south western part of the country. Surgery department is one of major specialty available in the hospital. General surgery is a unit under the department of Surgery and they are the one who manage a patient presented with perforated PUD.\u003c/p\u003e \u003cp\u003e Hospital-based descriptive cross sectional study with patients chart review was done from September 1, 2020 to August 30, 2025. All patients who were operated at JMC for PUD perforation during the study period were included in the study based on the inclusion criteria. \u003cb\u003eInclusion criteria\u003c/b\u003e was all patients who had been confirmed to have a PUD perforation intra-operatively. \u003cb\u003eExclusion criteria\u003c/b\u003e was those patients with incomplete chart and don\u0026rsquo;t have an intraoperative diagnosis of PUD perforation.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003e2.2. Data collection\u003c/h2\u003e \u003cp\u003eThe medical record number (MRN) of all patients operated for PUD perforation in JUMC during study period were collected from the OR logbook, and charts were retrieved from the hospital medical store room. A structured questionnaire was developed in English using KoboToolbox and used for data collection. The data collection team comprised four well-trained general surgery residents. Data were extracted and transferred into SPSS version 30 for statistical analysis\u003c/p\u003e \u003cp\u003eData extracted included detail history of the patients including presenting symptoms, duration symptoms, previous history of PUD, alcohol history, cigarette smoking, chat chewing habit, and use of Non-steroidal anti-inflammatory drugs (NSAIDS). All relevant physical finding at admission, operative findings and treatment were also recorded. The outcome was defined as the consequences that will occur as a result of PPUD that can be either favorable (patients that are discharged improved) or unfavorable (those who develop complications or died postoperatively).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003e2.3. Sample size\u003c/h2\u003e \u003cp\u003eThe sample size for the study was determined using single population proportion formula. n=({z_(a/2)}\u003csup\u003e2\u003c/sup\u003ep(⊢p))/d\u003csup\u003e2\u003c/sup\u003e. Where n\u0026thinsp;=\u0026thinsp;required sample size.\u003c/p\u003e \u003cp\u003eZa/2\u0026thinsp;=\u0026thinsp;level of significance of population at 95% confidence interval\u0026thinsp;=\u0026thinsp;1.96.\u003c/p\u003e \u003cp\u003eP\u0026thinsp;=\u0026thinsp;the proportion (P) outcome of PPUD in Adama hospital medical college is 14.2 (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e)\u003c/p\u003e \u003cp\u003ed\u0026thinsp;=\u0026thinsp;a 5% margin of error\u0026thinsp;=\u0026thinsp;0.05.\u003c/p\u003e \u003cp\u003eUsing the above equation n\u0026thinsp;=\u0026thinsp;187.2.\u003c/p\u003e \u003cp\u003eBecause of small number of cases operated for PUD perforation (N\u0026thinsp;=\u0026thinsp;181), which is less 10,000 and initially calculated sample size (187.2) represented more than 5% of this population (n\u0026thinsp;\u0026gt;\u0026thinsp;5% of N), the final sample size was determined using finite population correction formula.\u003c/p\u003e \u003cp\u003eN f\u0026thinsp;=\u0026thinsp;n = [(_(n/(1\u0026thinsp;+\u0026thinsp;n/N)))]. Where N is the number of patients operated for perforated PUD during the study period.\u003c/p\u003e \u003cp\u003eUsing above formula Nf\u0026thinsp;=\u0026thinsp;92\u003c/p\u003e \u003cp\u003eFinally, after adding a 10% non-response rate, the final sample size for the study became 102.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003e2.4. Quality control\u003c/h2\u003e \u003cp\u003eBefore data collection, pretest was conducted on 5% of the sample. The findings and observation obtained from the pretest was used to refine the checklist and improve the data collection process. To ensure data quality during the data collection period, the KoboToolbox form was programmed with validation rules such as range limits, skip logic, and mandatory fields to reduce entry errors and missing data. Data quality was also controlled through continuous supervision during data collection. All completed data collection forms were examined for completeness and consistency during data management, storage and analysis.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003e2.5. Statistical analysis\u003c/h2\u003e \u003cp\u003eData were analyzed using IBM SPSS Statistics. The mean standard deviation (SD), median and ranges was determined for continuous variables whereas proportions and frequency tables was used to summarize categorical variables. Using bivariate and multivariate logistic regression, respectively, the pattern of relationship between the dependent and independent variables is discovered. Chi-square (c2) test will be used to test for the significance of association between the independent (predictor) and dependent (outcome) variables in the categorical variables. At \u003cem\u003eP-value\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05, the relationship between the variables is deemed significant. The strength of the association between dependent and independent variables is expressed using adjusted odds ratio (AOR).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003e2.6. Ethical considerations\u003c/h2\u003e \u003cp\u003e \u003cstrong\u003eEthical approval\u003c/strong\u003e \u003cp\u003e was obtained from the institutional review board of Jimma University. Written informed consent of the patients was not included in the questionnaire since medical data were collected retrospectively and anonymity as well as confidentiality of the patients\u0026rsquo; medical data were maintained throughout the study. We also obtained a letter of consent to conduct research from department of surgery and submit to medical record room to commence data collection.\u003c/p\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"3. Results","content":"\u003cp\u003e \u003cb\u003eSocio-demographic characteristics\u003c/b\u003e \u003c/p\u003e \u003cp\u003eA total of 102 patients who had emergency laparotomies for perforated peptic ulcers during the study period were enrolled in the study. Twelve (11.8%) of them were female, and 90 (88.2%) were male. The ratio of men to women was 7.5: 1. The patients ranged in age from 15 to 75 years, with a mean age of 35.4 (SD\u0026thinsp;\u0026plusmn;\u0026thinsp;15.5) years. About 43 (42.2%) were from urban and 59(57.8%) from rural areas surrounding Jimma zone (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e\u003cb\u003e).\u003c/b\u003e\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eSocio-demographic characteristic of patients with perforated peptic ulcer disease, at JMC, Ethiopia.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariables\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCategory\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eFrequency\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePercentage (%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"6\" rowspan=\"7\"\u003e \u003cp\u003eAge\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e15.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e20-29yrs\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e27\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e26.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e30-39yrs\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e21.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e40-49yrs\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e15.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e50-59yrs\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e12.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e60-69yrs\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e4.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026gt;=70yrs\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSex\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e90\u003c/p\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e88.2\u003c/p\u003e \u003cp\u003e11.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eResidents\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eUrban\u003c/p\u003e \u003cp\u003eRural\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e43\u003c/p\u003e \u003cp\u003e59\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e42.2\u003c/p\u003e \u003cp\u003e57.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eEighty one (79.4%) patients reported previous history of dyspepsia or a history of treatment for peptic ulcer disease. Nine individuals out of the total enrolled patients have a history of alcoholism, and 42(41.2) of patients have a history of chat chewing. On the other hand, none of the patients had surgery for a perforated PUD (Table \u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eDistribution of risk factors among patients with perforated Peptic ulcer disease, JMC, Ethiopia\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eRisk factor variables\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eCategory\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eYes\u003c/b\u003e, N (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003eNo\u003c/b\u003e, N (%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePrevious history of dyspepsia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e81(79.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e21(20.6)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAlcohol consumption\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e9(8.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e93(91.2)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSmoking\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e8(7.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e94(92.2)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eChat chewing\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e42(41.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e60(58.8)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUse of NSAIDS\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e5(4.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e97(95.1)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eH. Pylori positive\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e4(3.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2(1.9)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePatient treated with PPI or H2 blocker\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e55(53.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e47(46.1)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePatient take eradication therapy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2(1.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e100(98.1)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eOnly (3.9%) of patients have the fifth level of American Society of Anesthesiologists (ASA) scores, whereas over two-thirds (72.2%) of patients have the second level (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eThe mean duration of symptoms was (41.78\u0026thinsp;\u0026plusmn;\u0026thinsp;32.4) SD hours, with a range of 2 hours to 6 days. Of the patients, forty-three (42.2%) presented in within twenty-four hours of the onset of symptoms, and more than 57.8% presented in more than twenty-four hours later (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e). Most patients in the current study presented with generalized abdominal pain 88(86.3%), while epigastric pain was accounted by 14(13.7%) patients. Eight (7.8%) patients presented with un-recordable systolic blood pressure (SBP). Sixty-four (62.7%) patients had a pulse rate (PR) more than 100 beats per minute, and sixteen (15.7%) patients had a systolic blood pressure of less than 90 mmHg. Out of a total number of localized peritonitis, eight patients have abdominal tenderness over right lower quadrant and seven patients have epigastric tenderness.\u003c/p\u003e \u003cp\u003eRegarding to laboratory findings, White blood cell (WBC) was normal (4000-10,000/mm3) in 50(49%) patients, 36(35.3%) of the patients had leukocytosis (WBC\u0026thinsp;\u0026gt;\u0026thinsp;10,000 /mm3) and about twenty (19.6%) patients had deranged renal function test (RFT) (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eClinical and laboratory finding of perforated peptic ulcer disease patients, at JMC, Ethiopia\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariables\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCategory\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eFrequency\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePercentage (%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eDuration of symptoms\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026lt;=24 hours\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e43\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e42.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;24 hours\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e59\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e57.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003ePresenting compliant\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGeneralized abdominal pain\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e88\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e86.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eEpigastric pain\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e13.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eAbdominal finding\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003egeneralized peritonitis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e85\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e83.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLocalized peritonitis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e14.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eno sign of peritonitis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eSBP\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNot recordable\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e7.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;90 mmhg\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e15.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026gt;=90 mmhg\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e78\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e76.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003ePR\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;100\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e32\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e31.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026gt;=100\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e64\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e62.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eLab finding\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eWBC at\u003c/p\u003e \u003cp\u003epresentation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLeucopenia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e15.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNormal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e49\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLeukocytosis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e36\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e35.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eRFT at presentation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNormal range\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e46\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e45.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAbnormal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e19.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNot done\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e36\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e35.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cb\u003eIntraoperative and procedure done\u003c/b\u003e \u003c/p\u003e \u003cp\u003eEighty-one patients (79.4%) had perforations on the anterior first part of the duodenum, while the other twenty patients (19.6%) had perforations on the pre-pyloric stomach. Size of perforation ranges from 0.1cm to 10cm with mean size of perforation (0.5\u0026thinsp;\u0026plusmn;\u0026thinsp;0.82 SD) cm. Seventy seven (75.5%) of the perforations were between 0.5cm and 1cm and 15 (14.7%) were \u0026gt;\u0026thinsp;1 cm. Approximately two-third of patients (64%) has an amount of peritoneal fluid greater than one litter (Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eIntra-operative finding of patients with perforated peptic ulcer disease, at JMC, Ethiopia.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCategory\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eFrequency\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePercent %\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eLocation of perforation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDuodenum\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e81\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e79.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePre-pyloric/gastric\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e19.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSealed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eSize of perforation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.5cm\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e9.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e05-1cm\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e77\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e75.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;1cm\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e14.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003ePeritoneal contamination\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;1L\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e38\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e37.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1-2L\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e44\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e43.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;2L\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e19.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eFor the majority, 86(84.3%) of the patients repair was done with omental pedicle alone. Other procedures, including simple repair, falciform ligament patch, and combinations with gastrojejunostomy, jejunostomy, or vagotomy, were performed in only a small number of patients (Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e). Sub hepatic drain was put for 20(19.6%) patients, pelvic drian for two patients, lesser sac posterior to the stomach for one patients, right paracolic gutter for one patients and right upper quadrant drain for one patient.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eRepairing mechanisms (procedures) for perforated Peptic ulcer disease patients, at JMC, Ethiopia.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTypes of procedure\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFrequency\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePercent %\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePedicle omental patch\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e86\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e84.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSimple repair\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFalcifarem ligament patch\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOmental patch\u0026thinsp;+\u0026thinsp;GJ+JF\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePedicle omental patch\u0026thinsp;+\u0026thinsp;Retrocolic GJ\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePedicled omental patch\u0026thinsp;+\u0026thinsp;GJ+ pyloric exclusion\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePedicled omental patch\u0026thinsp;+\u0026thinsp;GJ +trunkal vagatomy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSubtotal gastrectomy\u0026thinsp;+\u0026thinsp;GJ +JJ +duodenal stamp\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBiopsy taken\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e16.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"3\"\u003eNote;-GJ= gastro-jejunostomy, JF= jejunostomy feeding,\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003ch2\u003e\u003cb\u003ePostoperative outcome\u003c/b\u003e\u003c/h2\u003e\u003cp\u003eThirty seven (36.3) patients were post-operative complications recorded. Of these, superficial and deep surgical site infection 8(21.6%), intra- abdominal collections 6(16.2%) and hospital acquired infection (HAI) 4 (10.8%) were the commonest. Whereas, the others were postoperative such as wound dehiscence were the least complications (Table\u0026nbsp;\u003cspan refid=\"Tab6\" class=\"InternalRef\"\u003e6\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab6\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 6\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003epost-operative complication of patients with perforated peptic ulcer disease, at Jimma University Medical Center, Ethiopia\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eType complication\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFrequency\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePercent %\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSurgical site infection\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e21.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIntra-abdominal collection\u003c/p\u003e \u003cp\u003ewithout leak\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e16.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePatch failure\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e5.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGastric perforation\u0026thinsp;+\u0026thinsp;HAI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e5.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePatch failure +pneumonia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e5.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWound dehiscence\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e5.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHospital acquired infection\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e10.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRefractory septic shock\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e8.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDelay awakening\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e10.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eElectrolyte imbalance\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e5.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUpper GI bleeding\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAKI (acute kidney injury)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eThirteen 13/102 (12.7%) patients were undergone re-laparotomy of the procedure. Seven (53.8%) patients re-operated for post-operative intraoperative collection without patch failure, four (30.7%) patients due to patch failure, one patient due to Gastric perforation and one patient due to development of gangrene on distal ileum. Three patient undergone second re-laparotomy (2.9%) and one patient undergo 3rd re-laparotomy (0.98%) while the findings were leak from the perforation site in all of them.\u003c/p\u003e \u003cp\u003eFourteen (13.7%) patient were admitted to ICU after procedure and nine of the patients (64%) were died in the unit, whereas the rest of five patients (36%) transferred to surgical ward. Overall, eight seven (85.3%) patients were discharged improved and fifteen (14.7%) died (Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e4\u003c/span\u003e). Thirty-nine (44.8%) patients were discharged within 7 days (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e3\u003c/span\u003e\u003cb\u003e).\u003c/b\u003e However, only two patients were re-admitted to hospital.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003cb\u003eFactors associated with postoperative morbidity and mortality of patients with perforated peptic ulcer disease\u003c/b\u003e \u003c/p\u003e \u003cp\u003eAfter running a bivariate analysis, variables with P-values of less than or equal to 0.25 were selected as a candidate variable for the final model. Accordingly, variables age, address, previous history of PUD, duration of presentation, history of hypotension, perforation size, fluid contamination status, and Procedure done/repaired were found to be a candidate variable for the postoperative morbidity and mortality in this particular study. After controlling for the potential confounders at the multivariable logistic regression model, variables such as duration at presentation((\u003cb\u003eP\u003c/b\u003e-value\u0026thinsp;\u003cb\u003e=\u0026thinsp;0.021\u003c/b\u003e, AOR\u0026thinsp;=\u0026thinsp;\u003cb\u003e3.2\u003c/b\u003e, \u003cb\u003eCI\u003c/b\u003e = \u003cb\u003e(1.06, 9.59)\u003c/b\u003e, previous history of PUD ((\u003cb\u003eP\u003c/b\u003e-value\u0026thinsp;\u003cb\u003e=\u0026thinsp;0.021\u003c/b\u003e, AOR\u0026thinsp;=\u0026thinsp;\u003cb\u003e8.4\u003c/b\u003e, \u003cb\u003eCI\u003c/b\u003e = \u003cb\u003e(1.38,11.5)\u003c/b\u003e, history of hypotension((P-values\u0026thinsp;=\u0026thinsp;0.017, AOR\u0026thinsp;=\u0026thinsp;\u003cb\u003e4.5\u003c/b\u003e, \u003cb\u003eCI\u003c/b\u003e = \u003cb\u003e(1.31,15.7\u003c/b\u003e) and Procedure done/repaired ((\u003cb\u003eP\u003c/b\u003e-value\u0026thinsp;\u003cb\u003e=\u0026thinsp;0\u003c/b\u003e.012, AOR\u0026thinsp;=\u0026thinsp;\u003cb\u003e6.2\u003c/b\u003e, \u003cb\u003eCI\u003c/b\u003e = \u003cb\u003e(1.48,15.9)\u003c/b\u003e, were found to be statistically significant factors that were associated for postoperative morbidity/ complication among patients with perforated PUD in JMC (Table\u0026nbsp;\u003cspan refid=\"Tab7\" class=\"InternalRef\"\u003e7\u003c/span\u003e). Whereas, variables like Duration at presentation((\u003cb\u003eP\u003c/b\u003e-value\u0026thinsp;\u003cb\u003e=\u0026thinsp;0\u003c/b\u003e.038, AOR\u0026thinsp;=\u0026thinsp;\u003cb\u003e5.5\u003c/b\u003e, \u003cb\u003eCI\u003c/b\u003e = \u003cb\u003e(1.20,25.84)\u003c/b\u003e,, age of patients((P-value\u0026thinsp;\u003cb\u003e=\u0026thinsp;0\u003c/b\u003e.016, AOR\u0026thinsp;=\u0026thinsp;\u003cb\u003e3\u003c/b\u003e, \u003cb\u003eCI\u003c/b\u003e = \u003cb\u003e(1.60,6.62)\u003c/b\u003e,, history of hypotension((\u003cb\u003eP\u003c/b\u003e-value\u0026thinsp;\u003cb\u003e=\u0026thinsp;0\u003c/b\u003e.006, AOR\u0026thinsp;=\u0026thinsp;\u003cb\u003e6.4\u003c/b\u003e, \u003cb\u003eCI\u003c/b\u003e = \u003cb\u003e(1.79,11.98)\u003c/b\u003e, and Perforation size((\u003cb\u003eP\u003c/b\u003e-value\u0026thinsp;\u003cb\u003e=\u0026thinsp;0\u003c/b\u003e.030, AOR\u0026thinsp;=\u0026thinsp;\u003cb\u003e6\u003c/b\u003e, \u003cb\u003eCI\u003c/b\u003e = \u003cb\u003e(1.18,29.6)\u003c/b\u003e, were found to be statistically significant factors that were associated for postoperative mortality of patients with perforated PUD(Table\u0026nbsp;\u003cspan refid=\"Tab8\" class=\"InternalRef\"\u003e8\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab7\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 7\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eMultivariable logistic regression analysis for factors associated with postoperative morbidity of PPUD patients in JMC\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"7\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eVariables\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eCategory\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003eComplication after surgery\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eCOR (95% CI)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eP-value\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eAOR (95% CI)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eYes(%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eNo(%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eAge\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;60\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e32(34)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e62(66)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e.033\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026gt;=60\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5(62.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3(37.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e6.1(1.16,31.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e4.2(0.85,19.7)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eAddress\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eUrban\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e11(25.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e32(74.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e.058\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRural\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e26(44\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e33(56)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2.3(0.97,5.39)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e2.2(0.76,6.43)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eHistory of\u003c/p\u003e \u003cp\u003ePUD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3(14.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e18(85.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e.027\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e34(42)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e47(58)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e4.3(1.18,15.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003e8.4(1.38,11.5)*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eDuration at presentation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;24hrs\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e20(27.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e52(72.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e.007\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026gt;=24hrs\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e17(56.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e13(43.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3.4(1.4,8.25)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003e3.2(1.06,9.59)*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eHypotension\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e20(20.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e78(79.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e17(41.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e24(58.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e7(2.54,19.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003e4.5(1.31,15.7)*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003ePerforation size\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e=\u0026lt;1cm\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e27(30.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e61(69.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e.006\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;1cm\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10(71.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4(28.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e5.6(1.62,19.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e2.2(0.46,11.03)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eFluid contamination\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026lt;=1 litter\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e15(\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e50(77)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e.009\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;1 liter\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e18(48.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e19(51.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3.1(1.32,7.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1.9(0.62,6.23)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eProcedure done/repaired\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePedicle omental\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e26(30.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e60(69.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e.006\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOthers\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e11(68.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5(31.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e5(1.60. 16.08)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003e6.2(1.48,15.9)*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"7\"\u003e* \u003cem\u003eIndicates P-value\u0026thinsp;\u0026lt;\u0026thinsp;0.05\u003c/em\u003e\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab8\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 8\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eMultivariable logistic regression analysis for factors associated with postoperative mortality of PPUD patients in JMC\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"7\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eVariables\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eCategory\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003eOutcome of patients\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eCOR (95% CI)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eP-value\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eAOR (95% CI)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eDeath (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eImproved(%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eAge\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;60\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e12(12.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e82(87.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026gt;=60\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3(37.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5(62.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e4.1(0.86,19.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e.015\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003e3(1.60,6.62)*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eAddress\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eUrban\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4(9.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e39(90.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRural\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e11(18.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e48(81.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2.2(0.66,7.56)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e.196\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1.5(0.30,7.46)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eHistory of\u003c/p\u003e \u003cp\u003ePUD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1(4.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e20(95.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e14(17.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e67(82.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e4.2(0.51,33.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e.180\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e12.3(0.52,29.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eDuration at presentation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;24hrs\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6(8.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e66(91.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026gt;=24hrs\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9(30)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e21(70)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e4.7(1.5,14.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e.008\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003e5.5(1.20,25.84)*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eHypotension\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5(6.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e73(93.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10(41.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e14(58.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e10.4(3.09,35.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003e6.4(1.79,11.98)*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003ePerforation size\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e=\u0026lt;1cm\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9(10.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e79(89.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;1cm\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6(42.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e8(57.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e6.5(1.86,23.28)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e.003\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003e5.9(1.18,29.6)*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eProcedure done/repaired\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePedicle omental\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10(11.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e76(88.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOthers\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5(31.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e11(68.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3.4(0.99,12.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e.051\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e3.1(0.531,18.4)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eFluid contamination\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026lt;=1 litter\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5(7.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e64(92.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;1 liter\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10(30.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e23(69.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e5.5(1.72,18.01)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e.004\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e3.1(0.66,15.4)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"7\"\u003e* \u003cem\u003eIndicates P-value\u0026thinsp;\u0026lt;\u0026thinsp;0.05\u003c/em\u003e\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e"},{"header":"4. Discussion","content":"\u003cp\u003eThe predominance of male patients in this study align with previous report from Ethiopia and East Africa. In this region, perforated peptic ulcer disease (PPUD) affects men far more than women. Studies from hospitals in Addis Ababa and Adama Hospital Medical College reported male-to-female ratios of 6\u0026ndash;7:1 and 9:1 respectively and data from Jigjiga and Northwestern Tanzania similarly show male predominance (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan additionalcitationids=\"CR8\" citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e). This pattern is likely attributable to greater exposure among men in this region to known risk factors such as smoking, alcohol consumption, and khat chewing (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe average age of patients in our study was 35.4 years. This finding is also observed in regional trends which showed PPUD tends to affect younger adults in low-resource settings (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e). However, studies from high-income countries report a higher mean age, often in the 50\u0026ndash;60-year range (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e). This difference may indicate variation in Helicobacter pylori prevalence, dietary patterns, and access to healthcare that may contributed to earlier disease onset in developing regions (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eIn this study, 79.4% of patients had a prior history of dyspepsia which shows that chronic peptic symptom often precede perforation. Similar findings were reported in Ethiopia: 75% at Tikur Anbessa affiliated hospitals (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e) and 80% at Adama Hospital (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e), as well as 56% in south Nigeria (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e). In contrast, large Western population studies have documented significant declines in the incidence of perforated peptic ulcer after widespread use of proton pump inhibitors that shows a reduced chronic ulcer disease burden (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eOnly 3.9% of patients were documented as H. pylori positive. However, for the remaining their status were unknown, reflecting incomplete testing. Similar patterns are reported regionally: H. pylori testing was limited at Addis Ababa hospitals, and Jigjiga hospitals (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e). In contrast, Western studies report routine H. pylori screening and eradication, which significantly reduced its role in perforation (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e). This highlights the underdiagnosis of H. pylori in African settings may indirectly contributed to ulcer complications (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eHowever, in our study, only 1.9% had received H. pylori eradication therapy and only 54% treated with PPI or H2 blocker. This emphasizes a major gap in evidence-based management compared with Western standards (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eIn this study, 8.8% of patients reported alcohol use and 7.8% reported smoking. These rates are lower than those reported in other Ethiopian studies, such as 47 and 35% at tertiary hospital in Addis Ababa, respectively (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e) and 34 and 42% at Adama Hospital, respectively (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e). They are also lower than Western populations where smoking and alcohol consumption are more prevalent. For example, a Croatian surgical cohort reported smoking in 33.6% and alcohol use in 22.1% of patients (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e). The lower rate in this study may be due to under-reporting, cultural factors, or genuinely lower exposure (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eKhat chewing was observed in 41.2% of patients. This is higher than 9 and 18% reported from Addis Ababa hospitals (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e) and comparable to 45% at Adama Hospital and 56.6% at Jijjiga hospitals (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e). This regional habit is rarely reported in Western literature. Khat may contribute to mucosal injury through increased gastric acid secretion and delayed gastric emptying. This highlights the importance of local behavioral factors in East African PUD patients (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan additionalcitationids=\"CR8\" citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eIn this study, 4.9% of patients reported NSAID use. This is comparable to reports of 2% at Addis Ababa Hospital (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e) and significantly lower than 36.8% at Adama Hospital (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e). On the other hand, studies from high-income countries report NSAID as a major risk factor, particularly following the widespread use of proton pump inhibitors (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eIn this study, the mean duration of symptoms prior to presentation was 42 hours whereas 57.8% of patients present more than 24 hours after symptom onset. Regional studies report similar delays: 55% at Tikur Anbessa affiliated hospitals (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e), 71% at Adama Hospital (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e), and 71% in Northwestern Tanzania (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e). Such delays are common in low-resource settings due to geographic barriers, limited health literacy, reliance on traditional remedies, and possible under-recognition of perforation by initial healthcare providers (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e). However, patients in high-income countries typically present within hours of symptoms onset as result of widespread access to emergency services and diagnostic imaging. This allowed earlier surgical intervention and improved outcomes (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eIn this study, the majority of perforations (79.4%) involved the anterior first part of the duodenum. This is also consistent with both regional and global trends (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e). They reported duodenal involvement of 94% at Tikur Anbessa affliated hospitals (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e) and 81% at Adama Hospital (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e), as well as 93% in Northwestern Tanzania (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e). Western cohorts often show a relative higher proportion of gastric (pre-pyloric) perforations frequently associated with NSAID and aspirin use among elderly patients (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e). On the other hand, the predominance of duodenal perforation in this region likely reflects a strong link to H. pylori infection and regional dietary or environmental factors, which warrant further investigation (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan additionalcitationids=\"CR14\" citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe mean perforation size in this study was 0.5\u0026thinsp;\u0026plusmn;\u0026thinsp;0.82 cm. Most of the perforations (75.5%) measures 0.5\u0026ndash;1 cm and 14.7% exceeding 1 cm. This aligns with regional data, where small perforations predominate: Tikur Anbesa affiliated hospitals (81%) (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e), tertiary hospital of Addis Ababa (90%) (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e), Jigjiga (88%) (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e), and Nigerian center (49%) (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e). These small perforations are typically amenable to simple omental patch repair (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e). Meanwhile, Western settings report larger perforations often related to NSAID-induced gastric ulcers or malignancy (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e). Such perforation requires more complex interventions such as partial gastrectomy (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eRegarding peritoneal contamination, 64% of patients had more than one liter of peritoneal pus. This shows delayed presentation and advanced peritonitis. (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e) Although regional studies rarely quantify contamination volume, reports from Addis Ababa, Adama, Jigjiga, and other sub-Saharan centers similarly describe gross peritoneal contamination at surgery (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e). By contrast, Western patients present earlier, with lower contamination volumes and improved postoperative outcomes due to timely access to emergency care and imaging (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eIn this study, pedicled omental patch repair was the most performed procedure. It accounted for 84.3% of cases. This reflects the simplicity, and effectiveness of the technique in emergency settings (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e). Regional and international studies report similar trends: tertiary hospital of Addis Ababa, Ethiopia (92.6%) (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e), Adama Hospital (89%) (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e), Jigjiga (98%) (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e), Northwestern Tanzania (83%) (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e), and Nigerian centers (77 \u0026amp; 89%) (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e) all show a predominance of omental patch closure for small duodenal perforations. The procedure provides a rapid and safe solution for patients often presenting late or in poor general condition which is a common scenario in low-resource settings (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eA smaller proportion of patients underwent alternative or adjunctive procedures. This included simple repair (2%), falciform ligament patch (2.9%), and combined procedures such as omental patch with gastrojejunostomy (GJ), pyloric exclusion, or truncal vagotomy. These interventions were reserved for large ulcers or those with failed patch (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e). Similarly, regional studies report limited use of these alternative or complex procedures, including Tikur Anbessa affiliated hospitals, Jigjiga, and Northwestern Tanzania (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e). In our study, one patient (1%) required a subtotal gastrectomy with GJ and jejunojejunostomy (JJ) as definitive ulcer surgery.\u003c/p\u003e \u003cp\u003eIn Western practice, the management of perforated PUD has evolved substantially. Effective medical therapy has greatly reduced the need for definitive anti-ulcer procedures, especially for duodenal perforations (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e). Laparoscopic omental patch repair is now considered the gold standard in many high-income centers for hemodynamically stable patients with small perforations. It offers reduced postoperative pain, faster recovery, and shorter hospital stay (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e). On the other hand, in regional settings such as Ethiopia and neighboring countries, laparoscopic surgery remains limited due to resource constraints, and insufficient expertise. This makes open pedicled omental patch repair the most practical and effective option in regional setting (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe use of falciform ligament patch repair (2.9%) in this study is noteworthy. While regional cohorts rarely report this technique, it demonstrates a practical alternative when the greater omentum is unavailable (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan additionalcitationids=\"CR8\" citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e). Evidence from Australia practice supports its safety and efficacy (\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e). However, in Western practice, such techniques are rarely needed due to earlier presentation and timely intervention (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e).\u003c/p\u003e \u003cp\u003ePostoperative complications occurred in 36.3% of patients. This is higher than rates reported in high-income countries where morbidity following PPUD repair typically ranges from 5\u0026ndash;20% due to advanced perioperative care and laparoscopic approaches (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e). Regional studies report comparable complication rates: Ethiopia (Addis Ababa tertiary hospitals 23% [7], Adama 28% [8], Jigjiga 29% [9]), Northwestern Tanzania 30% (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e), and Nigeria greater than and equal to 20% (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e). This indicates that outcomes in this study are consistent with the regional context. The elevated complication rate may result from delayed presentation, limited ICU capacity, and variability in perioperative care. While omental patch repair is effective, its success depends on timely intervention and adequate resuscitation\u0026mdash;factors often compromised in emergency settings with constrained resources (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan additionalcitationids=\"CR14 CR15\" citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eIn this study, several factors independently predicted postoperative morbidity and mortality. Delayed presentation independently predicted postoperative morbidity (AOR\u0026thinsp;=\u0026thinsp;3.2) and mortality (AOR\u0026thinsp;=\u0026thinsp;5.5), highlighting the central role of timely care in low-resource settings. This is consistent with an Ethiopian meta-analysis identifying delayed presentation and preoperative hypotension as major determinants of unfavorable outcomes (\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e). In addition, multicenter data from Jigjiga associated late presentation and shock to complications and death (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e). Although some regional studies lack adjusted analyses, they uniformly report poorer outcomes with delayed presentation (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e). In contrast, earlier presentation and lower mortality in high-income settings reflect rapid referral and prompt surgery (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eA prior history of PUD also independently predicted postoperative morbidity in this study (AOR\u0026thinsp;=\u0026thinsp;8.4). This suggests that chronic ulceration may predispose patients to more severe perforations or delayed recognition of symptoms. Although most regional studies report previous ulcer symptoms descriptively, they consistently show that 40\u0026ndash;80% of patients had antecedent dyspepsia or known PUD (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e). A similar patterns were also seen across other African cohorts (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e). In contrast, lower recurrence and complication rates in high-income settings reflect routine \u003cem\u003eH. pylori\u003c/em\u003e testing and eradication and widespread use of proton pump inhibitor. These interventions have limited ulcer persistence and progression to perforation (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eHypotension at presentation was strong predictor of both postoperative morbidity (AOR\u0026thinsp;=\u0026thinsp;4.5) and mortality (AOR\u0026thinsp;=\u0026thinsp;6.4) in our study. This is consistent with its role as marker of systemic compromise and sepsis (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e). This finding is similar with the Ethiopian meta-analysis, which identified preoperative hypotension as a major determinant of unfavorable outcomes after perforated PUD (\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e). Regional studies from Ethiopia and Tanzania report that 20\u0026ndash;30% of patients present in shock and similarly associated strongly with postoperative complications and death (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e). In contrast, lower morbidity and mortality in well-resourced settings are attributed to prompt resuscitation, vasopressor support, and early source control, which mitigate the physiologic impact of shock (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eSurgical procedure type independently predicted postoperative morbidity in this study (AOR\u0026thinsp;=\u0026thinsp;6.2). This is likely reflects ulcer severity and operative approach. A higher complication rates are observed in patients requiring more extensive procedures for large or complex perforations (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan additionalcitationids=\"CR12\" citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e). In contrast, selected patients in well-resourced settings increasingly undergo laparoscopic patch repair that has been associated with lower morbidity and shorter hospital stay (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e). However, open repair remains the standard in most African centers due to limited resources (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan additionalcitationids=\"CR20\" citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eAge and perforation size independently predicted mortality in this study. These findings are consistent with global evidence that elderly patients and those with larger defects face higher perioperative risk (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e). The Ethiopian meta-analysis identified advanced age as a major determinant of poor outcomes (\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e). In addition, regional cohorts from Ethiopia, Nigeria, Tanzania, and Liberia report similar associations (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan additionalcitationids=\"CR12\" citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e). However, the magnitude of association in our study (AOR\u0026thinsp;=\u0026thinsp;3 for age and AOR\u0026thinsp;=\u0026thinsp;6 for perforation size ), suggests that that these factors may be amplified by delays in care and limited perioperative monitoring. In high-income settings, early diagnosis, optimized resuscitation, and intensive monitoring mitigate these risks (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e).\u003c/p\u003e"},{"header":"5. Conclusions","content":"\u003cp\u003eIn this study, perforated peptic ulcer disease predominantly affected young male patients and the majority of perforations occurred in the first part of the anterior duodenum. Most patients presented after 24 hours of symptom onset, resulting in extensive peritoneal contamination and high postoperative complication rate. The pedicled omental patch was the most frequently performed procedure and provided favorable outcomes in most cases. Delayed presentation, advanced age, large perforation size, hypotension at admission, and type of surgical procedure were significant predictors of morbidity and mortality. These findings underscore the continued burden of perforated peptic ulcer disease in our setting. Therefore, improving outcomes in perforated peptic ulcer disease requires strengthening perioperative care. This include standardizing protocols, expanding critical care capacity, and gradual adoption of laparoscopic repair. In addition, community education on early symptoms recognition and modification of risk behaviors are also important to promote timely care. At the system level, integration of \u003cem\u003eHelicobacter pylori\u003c/em\u003e screening into primary care and development of national clinical guidelines are crucial. Furthermore, improved referral and enhanced diagnostic capacity are essential. Finally, sustained investment in surgical infrastructure and workforce development are necessary to reduce disease burden and improve surgical outcomes.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cdiv class=\"DefinitionList\"\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u0026bull; \u003cb\u003eASA\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eAmerican Society of Anesthesiologists\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u0026bull; \u003cb\u003eAKI\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eAcute Kidey injury\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u0026bull; \u003cb\u003eAOR\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eAdjusted Odds Ratio\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u0026bull; \u003cb\u003eCI\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eConfidence Interval\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u0026bull; \u003cb\u003eCOR\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eCrude Odds Ratio\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u0026bull; \u003cb\u003eGJ\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eGastrojejunostomy\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u0026bull; \u003cb\u003eHAI\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eHospital acquired infection\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u0026bull; \u003cb\u003eJF\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eJejunal Feeding\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u0026bull; \u003cb\u003eJJ\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eJejunojejunostomy\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u0026bull; \u003cb\u003eJMC\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eJimma University Medical Center\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u0026bull; \u003cb\u003eMRN\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eMedical Record Number\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u0026bull; \u003cb\u003eNSAID\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eNon\u0026ndash;Steroidal Anti\u0026ndash;Inflammatory Drug\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u0026bull; \u003cb\u003ePPUD\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003ePerforated Peptic Ulcer Disease\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u0026bull; \u003cb\u003ePR\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003ePulse Rate\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u0026bull; \u003cb\u003ePUD\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003ePeptic Ulcer Disease\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u0026bull; \u003cb\u003eRFT\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eRenal Function Test\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u0026bull; \u003cb\u003eSBP\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eSystolic Blood Pressure\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u0026bull; \u003cb\u003eSD\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eStandard Deviation\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u0026bull; \u003cb\u003eWBC\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eWhite Blood Cell (count)\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003c/div\u003e"},{"header":"Declarations","content":"\u003ch3\u003e\u003cstrong\u003eEthical approval and consent to participate\u003c/strong\u003e\u003c/h3\u003e\n\u003cp\u003eEthical approval was obtained from \u003cstrong\u003ethe Institutional Review Board (IRB) of Jimma University Institute of Health\u003c/strong\u003e, Ethiopia (Ethical clearance number: JUIH/IRB/0471/25). The requirement for informed consent \u003cstrong\u003ewas\u003c/strong\u003e \u003cstrong\u003enot required\u0026nbsp;\u003c/strong\u003eby the IRB due to the retrospective nature of the study\u003cstrong\u003e.\u003c/strong\u003e Patient data were anonymized and kept confidential.\u003c/p\u003e\n\u003ch3\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/h3\u003e\n\u003ch3\u003e\u003cstrong\u003eNot applicable. No individual patient data are presented that require consent for publication.\u003c/strong\u003e\u003c/h3\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eThe dataset(s) supporting the conclusions of this article are available from the corresponding author on reasonable request.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors'\u003c/strong\u003e \u003cstrong\u003econtributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDr. Gutu Ganati Tola (\u003c/strong\u003e\u003cstrong\u003eCorresponding author\u003c/strong\u003e\u003cstrong\u003e)\u003c/strong\u003e: conceived and designed the study, developed the methodology, and defined the research objectives; verified, and managed patient data, prepared it for analysis, and discussed the findings; drafted the manuscript, integrated relevant literature, critically revised it for clarity and scientific rigor, coordinated co-author input, and approved the final version as the first and corresponding author.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTemesgen Temitim Demis\u003c/strong\u003e: Performed the statistical analysis, applied appropriate tests, interpreted the results, and contributed to data visualization. Assisted in the interpretation of findings for the manuscript and reviewed relevant sections to ensure accuracy and clarity in reporting the results.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDr.\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eZemzem Mohammed Selamo\u003c/strong\u003e\u003cstrong\u003e:\u003c/strong\u003e Participated in data collection from patient records, ensured completeness and accuracy of the dataset, and assisted in data management.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDr. Seifu Alemu Taye\u003c/strong\u003e: participated in the study design, methodology development, and the research objectives definition; reviewed and proofread the manuscript; provided feedback on clarity, formatting, and overall readability.\u003c/p\u003e\n\u003cp\u003eAll authors reviewed the manuscript and approved the final version for submission.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eNot applicable.\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eClinical trial number\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eBupicha JA, Gebresellassie HW, Alemayehu A. 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ANZ J Surg. 2024;94(3):371\u0026ndash;4. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1111/ans.18728\u003c/span\u003e\u003cspan address=\"10.1111/ans.18728\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Perforated peptic ulcer disease, omental patch, surgical outcomes, morbidity, mortality","lastPublishedDoi":"10.21203/rs.3.rs-8747676/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8747676/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003ePeptic ulcer disease (PUD) is a common disease, which is a global public health concern. Whereas perforated peptic ulcer disease (PPUD) is a significant surgical emergency in low-resource settings, with high morbidity and mortality. Risk factors and outcomes differ from high-income countries due to variations in healthcare access, patient behaviour, and surgical practice.\u003c/p\u003e\u003ch2\u003eMaterials and methods\u003c/h2\u003e \u003cp\u003eA tertiary hospital-based, retrospective, cross-sectional study was conducted over 5 years. The sample size (n\u0026thinsp;=\u0026thinsp;102) was calculated using a single population proportion formula, based on expected PPUD outcome, a 95% confidence level, and 5% margin of error. Demographic, clinical, intraoperative, and postoperative data were analyzed. Associations between patient factors, perforation characteristics, surgical procedures, and outcomes were assessed using multivariate logistic regression.\u003c/p\u003e\u003ch2\u003eResult\u003c/h2\u003e \u003cp\u003eMost patients were young males (mean age 35.4 years). 57.8% of the patients presented more than twenty-four hours later. Eighty-one patients (79.4%) had perforations on the anterior first part of the duodenum. For the majority, 86(84.3%) of the patients repair was done with omental pedicle alone. Post-operative complications were recorded in thirty seven (36.3) patients. Significant predictors of adverse outcomes were delayed presentation, advanced age, hypotension at admission, large perforation size, and type of surgical procedure.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003ePPUD in our setting predominantly affects young males and duodenal ulcers whereas delayed presentation contributed to high morbidity. Pedicled omental patch repair remains the mainstay of treatment. In order to reduce complications and mortality in resource-limited settings, improving early recognition, timely referral, and perioperative care are crucial.\u003c/p\u003e","manuscriptTitle":"Determinants of morbidity and mortality in perforated peptic ulcer disease: A retrospective study at Jimma University Medical Center, Ethiopia","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-03-11 12:02:42","doi":"10.21203/rs.3.rs-8747676/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"ad8a0eac-d47c-47b1-8c5d-91dd589429c2","owner":[],"postedDate":"March 11th, 2026","published":true,"recentEditorialEvents":[{"type":"decision","content":"Rejected","date":"2026-05-15T17:15:09+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-05-11T07:23:29+00:00","index":78,"fulltext":""}],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2026-05-15T17:24:16+00:00","versionOfRecord":[],"versionCreatedAt":"2026-03-11 12:02:42","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8747676","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8747676","identity":"rs-8747676","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}