High rate of surgical site infection in the present study may be attributed YH25448 to contamination of the laparotomy wound during the surgical procedure. Perforated peptic ulcer is a serious condition with an overall reported mortality of 5%-25%, rising to as high as 50%

with age [5–7, 9, 11, 44]. In this study mortality rate was high in patients who had age ≥ 40 years, delayed presentation (>24 hrs), shock at admission (systolic BP < 90 mmHg), HIV positivity, low CD4 count (< 200 cells/μl) and concomitant diseases. Also gastric ulcers were associated with an increased mortality risk. Boey's score, which is a score based on scoring factors as shock on admission, confounding medical illness, and prolonged perforation, has been found to be a useful tool in predicting outcome [11]. In this study, Boey score was a good predictor of both mortality and postoperative

complication and therefore should be used in our setting as a tool for predicting outcome in patients with perforated peptic ulcers. Since tests for detecting H. Pylori was not possible in our patients due to logistic problems, we did not take this into consideration in our discussion. However the use of the ‘triple regime’ produced TEW-7197 mw excellent results in 82.6% of our patients which is comparable to the results from recent studies [3. 4, 21, 22, 45] which have successfully used simple closure AZD6094 cost followed by eradication of H-Pylori as a treatment for perforated peptic ulcer. This is in contrast to the earlier studies [46, 47] which reported emergency definitive surgery as a means to prevent recurrence and re-operation rates. These findings are extremely important for developing countries like Tanzania where delay in presentation often prevents any attempt at definitive surgery. Before generalizing the results of our study several important issues need to be addressed. First, since all the subjects in the present study underwent pen repair, results from this study may not fully

represent those after laparoscopic repair. Second, we did not study the association of H. pylori with the postoperative outcomes because of lack of necessary facilities at the study center. Third, Suplatast tosilate data obtained retrospectively and failure to detect HIV infection during window period may have underestimated the prevalence of HIV infection. Fourth, since our duration of postoperative follow up was relatively short, we could not estimate the long term effect of Graham’s omental patch. Conclusion Perforation of peptic ulcer remains a frequent clinical problem in our environment predominantly affecting young males not known to suffer from PUD. Simple closure with omental patch followed by Helicobacter pylori eradication was effective with excellent results in majority of cases despite patients’ late presentation in our center.