Study subject Selleck MCC-950 The subjects of this study included all patients who
were operated for perforated peptic ulcers at Bugando Medical Centre during the period under study. Patients with incomplete data were excluded from the study. Patients treated conservatively and those who failed to consent for HIV infection were also excluded from the study. The details of patients who presented from April 2006 to March 2008 were retrieved retrospectively from patient registers kept in the Medical record departments, the surgical wards, and operating theatre. Patients who presented to the A & E department between April 2008 and March 2011 were prospectively enrolled in the study after signing an informed written consent for the study. A detailed history and thorough physical examination were followed by investigations like full blood count, blood grouping, serum urea, serum creatinine and buy Anlotinib random blood sugar. Patients were also screened for HIV infection using rapid test/ELISA test. A determination of CD 4 count was also performed in all HIV positive patients. Radiological investigations like X-ray abdomen erect and chest X-ray were done in all patients on the suspicion of diagnosis of perforated PUD. Other investigations included hematological profile, serum urea and electrolytes and urinalysis. The diagnosis of perforated
PUD was made from history, plain abdominal and chest radiographs, and confirmed at laparotomy. Patients were put on intra-venous fluids, nasogastric suction, intravenous antibiotics and intravenous
anti-ulcer drugs; adequate hydration was indicated by an hourly urine MLN2238 manufacturer output of 30 ml/hour. After adequate resuscitation, laparotomy was done through midline incision and identified the perforation site. Simple closure of the perforation and reinforcement with pedicled omental patch (Graham’s omentopexy) was done. Thorough peritoneal lavage with 3 to 4 liters of normal saline was followed by placement of intraperitoneal drain. The operations were performed either by a consultant surgeon or a senior resident under the direct supervision Etofibrate of a consultant surgeon. The Boey score  as a tool for outcome prediction was calculated based on data recorded at the time of admission to hospital. The Boey risk stratification in perforated peptic ulcer consists of associated medical illness, preoperative shock and long-standing perforation (more than 24 hours). Preoperative shock was defined as a preoperative systolic blood pressure of less than 90 mmHg. All the patients were put on triple regime consisting of Amoxicillin (500 mg TID), Metranidazole(400 mg TID) and Omeprazole (20 mg BID), all given orally for 14 days to eradicate H. Pylori. Patients were followed up on an out patient basis for up to 12 months after surgery.