Work

Outcomes and Prognostic Factors in NSAID-related Upper Gastrointestinal Perforations: A Single-center Surgical Experience

Year: 2026

Type: article

Abstract: Background: Non-steroidal anti-inflammatory drug (NSAID)-induced perforated peptic ulcer (PPU) is a life-threatening surgical emergency, particularly in migrant labor populations with unmonitored over-the-counter access to analgesics.Aim: To evaluate the clinicopathological profile, operative outcomes, and prognostic utility of the Peptic Ulcer Perforation (PULP) score in patients presenting with NSAID-related gastroduodenal perforations.Methods: A retrospective cohort study was conducted at Misurata Medical Center between January 2021 and October 2025, enrolling 50 consecutive adult patients who underwent emergency laparotomy for operatively confirmed, NSAID-associated upper gastrointestinal perforations. Demographics, laboratory parameters, operative findings, and postoperative outcomes were extracted. All eight PULP score components were computed, and postoperative outcomes were analyzed across risk categories using univariate two-tailed Fisher’s exact tests.Results: The mean age was 37.0 ± 9.1 years (range: 18–55) with a male predominance (94.0%, n = 47), consisting primarily of migrant manual laborers (60.0% Nigerian, 24.0% Egyptian). Gastric perforations predominated (84.0%, n = 42), with sizes ranging from 15 to 30 mm. Comorbidities were documented in 24.0% (n = 12). Preoperative upright radiographs confirmed pneumoperitoneum in 68.0% (n = 34), computed tomography confirmed the diagnosis in 24.0% (n = 12), and 8.0% (n = 4) required urgent exploratory laparotomy. The mean PULP score was 4.42 ± 3.49; 26.0% (n = 13) were categorized as high risk (score > 7). Assessment of all eight PULP components showed that serum creatinine > 1.47 mg/dL (54.0%, n = 27), surgical delay > 24 hours (50.0%, n = 25), and American Society of Anesthesiologists (ASA) physical status class ≥ III (54.0%, n = 27) were the principal contributors to elevated risk scores, whereas age > 65 years (0.0%) and active malignancy (0.0%) were absent. Overall intensive care unit (ICU) admission was 26.0% (n = 13), postoperative leak requiring relaparotomy was 6.0% (n = 3), and 30-day mortality was 4.0% (n = 2). High-risk PULP status (> 7) was significantly associated with postoperative leak (p = 0.014) and ICU admission (p < 0.001); although both mortalities occurred exclusively within the high-risk cohort (15.4% vs. 0.0%), this difference did not reach statistical significance (p = 0.063).Conclusion: NSAID-related perforations in this setting characterize a distinct demographic—young, male manual workers presenting with large gastric ulcers and delayed surgical consultation. Preoperative renal dysfunction, higher preoperative ASA class, and diagnostic delays represent the primary drivers of adverse outcomes. In this preliminary cohort, a PULP score > 7 demonstrated significant univariate associations with ICU admission and postoperative repair leak, suggesting potential utility as an adjunct for perioperative critical care triage, although larger multicenter studies are required to validate its independent mortality prediction.

Source: International Journal of Clinical and Experimental Ophthalmology

DOI: 10.29328/journal.ijceo.1001068

Authors: Fathi Mohamed Elzowawi, Mustafa Jamal El-Swiah, Monjid Ahmed Ibrahim, Ayman Balla Mustafa

Institutions: Misurata University, Shaqra University

Language: English

Topic: Gastrointestinal Bleeding Diagnosis and Treatment

Subfield: Gastroenterology

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: diamond

OpenAlex ID: W7225630432