Kubtan MA, Alsharif AM, Al Sharif MN (2018) Role of Clinical Decision and Management of Patients Admitted with Perforated Peptic Ulcer to Damascus Hospital (Al Moujtahed), Damascus, Syria. Int J Surg Res Pract 5:087.


© 2018 Kubtan MA, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

RESEARCH ARTICLE | OPEN ACCESSDOI: 10.23937/2378-3397/1410087

Role of Clinical Decision and Management of Patients Admitted with Perforated Peptic Ulcer to Damascus Hospital (Al Moujtahed), Damascus, Syria

Muhammad Assem Kubtan*, Alaa Mousa Alsharif and Mhd Nezar Al Sharif

Department of Surgery, Syrian Private University, Damascus, Syria



As far as we know, there has been no previous published studies concerning the incidence of perforated peptic ulcer (stomach, duodenum) and its related risk factors in Syria, and their managements in association with the current Syrian conflict, that precipitated limited access to admitting such cases to over populated beds. This study addressing the burden shouldered by Health professionals, and aimed to determine the Prevalence of perforated peptic ulcer (PPU) in patients admitted to Damascus Hospital between 24/11/2015-4/11/2017, needless to mention also describe the values of making the diagnosis on clinical bases, and based on the principles that we are under the insult of our current dilemma namely civil conflict in Syria, precipitated shortening of all necessities to provide good and acceptable management with hope of achieving absolute cure.

Materials and methods

Retrospectively, we examined the data derived from cases of 67 patients who has been admitted and diagnosed as PPU, they had at least one or more risk factor leading to PPU (smoking, stimulants, non-steroidal anti-inflammatory drugs NSAIDS...). Those patients' symptoms almost initiated about 24 hours prior to admission. Their age ranged between 15-80 years-old. Data were analyzed using the Roc Curve and Kendall's tua-b factor and box plots using SPSS 23.0.


48 cases diagnoses proved as perforated duodenal ulcer (P.D.U) (71.6%), and 19 cases diagnoses proved as perforated gastric ulcer (P.G.U) (28.4%) with one perforated gastric ulcer proved to be malignant confirmed by four quadrants biopsies. 22 cases of all proved to be drug-induced perforated ulcer (D.I.P.U) (32.8%) as duodenal or gastric in 13 and 9 cases, respectively. Significant correlation was found between drug-induced perforated ulcer D.I.U, smoking, other stimulants (coffee and tea) and hypertension. Furthermore, a significant correlation was found between taking NSAID and PGU, P.D.U and (D.I.P.U).


Almost always diagnosis was made on clinical experience, as there was extreme shortage even complete absence of X-ray films to confirm the diagnosis by seeing gas under the diaphragm which was seen by observing the X-ray monitor, X-ray films are saved for other more important clinical problems mainly orthopedic trauma. The mean age of participants was 48 years old, and the males were more common 87% with a male to female ratio 6:1. The most common PPU was duodenal 71.6% of all patients. Patients taking NSAIDs have a higher risk for developing gastric ulcer (P = 0.045) and D.I.U (P = 0.000).