Perforated peptic ulcer is a common surgical emergency condition worldwide, which is associated with significant morbidity and mortality if early diagnosis and immediate surgical management were not carried out. Perforation occurs in roughly 5% of PUD patients during their lifetime; this study aimed to explore the wide range of clinical presentations, associated risk factors, complications, and surgical management of perforated peptic ulcer patients. A 5-year retrospective observational study on the clinical presentation and surgical management of perforated peptic ulcer is carried out in a tertiary hospital in Mogadishu, Somalia, Department of General Surgery, from January 2017 to December 2021. We included all patients undergoing operations with an intraoperative confirmed diagnosis of perforated peptic ulcer at the general surgery department. For operated patients, follow-up evaluation was performed in the outpatient department. Fifty-one patients underwent an emergency operation for perforated peptic ulcer during the study period. The sociodemographic distribution of patients was 45 (88.2%) males and 6 (11.8%) females, giving a male-to-female ratio of 7.5:1. The mean age of patients was 35.5 ± 16.8 years, and the peak frequency was in the third decade. The commonest presenting symptoms were sudden onset of severe epigastric pain in 42 (82.4%) patients. Patients who presented perforated peptic ulcer within 24 h of initiation of symptoms were free from complications. Age-group and delayed presentation > 48 h after onset of symptoms were linked to postoperative complications and were statistically significant (P 0.032 and P 0.005), respectively. Four patients died (mortality rate of 7.8%). Two patients were reoperated because of the failed primary repair, and 4 patients had > 5 cm intra-abdominal abscess image-guided percutaneous drainage, and the rest were given antibiotic therapy according to peritoneal fluid culture and sensitivity results. The most common microorganism isolated was E. coli 22% and Klebsiella 11%. Other rare microorganisms (pseudomonas, Staphylococcus aureus, and Candida spp.) were identified. In half (51%) of the patients with peritoneal fluid culture, no microorganism growth was seen. The distribution of perforated peptic ulcer is common in the young age-group in the third decades of life. Delayed presentation of the disease is linked because most patients arrived from remote areas where proper facilities of health care and health education are not available and the patient might come to the hospital in an advanced stage of the disease. We suggest conducting further researches, health awareness related to complications over-the-counter drugs self-medication, and bad habit including smoking, and to improve health-seeking behaviors of society.

中文翻译：

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索马里摩加迪沙一家三级医院消化性溃疡穿孔的临床表现和外科治疗：一项为期 5 年的回顾性研究

穿孔性消化性溃疡是世界范围内常见的外科急症，如果不进行早期诊断和立即手术治疗，会导致显着的发病率和死亡率。大约 5% 的 PUD 患者在其一生中发生穿孔；本研究旨在探讨消化性溃疡穿孔患者的广泛临床表现、相关危险因素、并发症和手术治疗。2017 年 1 月至 2021 年 12 月，在索马里摩加迪沙的一家三级医院普外科对穿孔性消化性溃疡的临床表现和手术治疗进行了为期 5 年的回顾性观察研究。我们纳入了所有接受手术的患者。术中在普外科确诊为穿孔性消化性溃疡。对于手术患者，在门诊进行随访评估。在研究期间，51 名患者因消化性溃疡穿孔接受了紧急手术。患者的社会人口分布为 45 名（88.2%）男性和 6 名（11.8%）女性，男女比例为 7.5:1。患者的平均年龄为 35.5 ± 16.8 岁，高峰出现在第三个十年。最常见的症状是 42 名 (82.4%) 患者突然出现严重的上腹痛。在症状出现后 24 小时内出现穿孔性消化性溃疡的患者无并发症。年龄组和症状发作后 > 48 小时的延迟就诊与术后并发症有关，并且分别具有统计学意义（P<0.032 和 P<0.005）。4 名患者死亡（死亡率为 7.8%）。2例因一期修复失败再次手术，4例腹腔脓肿>5 cm影像引导下经皮引流，其余患者根据腹水培养及药敏结果给予抗生素治疗。最常见的分离微生物是 22% 的大肠杆菌和 11% 的克雷伯氏菌。鉴定出其他稀有微生物（假单胞菌、金黄色葡萄球菌和念珠菌属）。在半数（51%）的腹膜液培养患者中，未见微生物生长。穿孔性消化性溃疡的分布常见于 30 岁的青年组。疾病的延迟出现是相关的，因为大多数患者来自偏远地区，那里没有适当的医疗保健和健康教育设施，而且患者可能在疾病的晚期才来医院。我们建议开展进一步的研究，提高与非处方药并发症相关的健康意识，以及包括吸烟在内的不良习惯，以改善社会的健康行为。