ArticleBMC gastroenterology2026
Perforated peptic ulcer disease in a resource-limited setting: a retrospective analysis of a South African cohort.
Article in BMC gastroenterology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundPerforated peptic ulcer disease (PPUD) is a surgical emergency with high morbidity and mortality, particularly in resource-limited settings where contemporary data is scarce. This study aimed to describe the epidemiology, risk profile, and outcomes of PPUD in a South African tertiary hospital, presenting it as a case study for similar low- and middle-income country (LMIC) environments.
methodsA retrospective, cross-sectional analysis was conducted on all patients who underwent emergency surgery for intraoperatively confirmed PPUD at a single tertiary centre between January 1, 2022, and December 31, 2024. Data on demographics, clinical presentation, risk factors, operative findings, and postoperative outcomes were extracted from medical records. Descriptive and univariable exploratory statistics were used for analysis.
resultsA total of 83 patients were included. The cohort was predominantly male (83.1%) with a median age of 42 years. A high prevalence of modifiable risk factors was identified, including smoking (75.9%), alcohol use (63.9%), and, notably, methamphetamine use (18.1%). In contrast to established global patterns, prepyloric (45.8%) and gastric (31.3%) perforations were more common than duodenal perforations (22.9%). Delayed presentation was prominent, with a median symptom duration on arrival of two days contributing to high rates of preoperative shock (21.7%) and acute kidney injury (AKI; 53.0%). The overall postoperative morbidity rate was 33.7%, and the in-hospital mortality rate was 15.7%. Upon univariable comparison, potential predictors of mortality included advanced age (p = 0.008), female sex (p = 0.007), hypotension on admission (p = 0.030), preoperative AKI (p = 0.016), anaemia (haemoglobin < 10 g/dL; p = 0.018), and a higher Boey score (p = 0.003).
conclusionPPUD in this South African setting affects a younger, predominantly male population with a unique risk profile characterised by high rates of substance use. The anatomical distribution diverges from established patterns, suggesting a distinct regional pathophysiology. Delayed presentation is a critical determinant of adverse outcomes, underscoring the need for public health interventions and systemic improvements to reduce delays in accessing surgical care in LMICs.
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