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More than half of patients admitted to Los Angeles County Hospital with perforated duodenal ulcers already have sealed their lesion spontaneously.
Such cases, in which absence of spillage has been radiologically confirmed, should not ordinarily undergo surgery, according to Clarence J. Berne, MD.
In one series, the University of Southern California surgeon said, the ulcers of 99 of 185 patients had sealed on arrival at the hospital. After nasogastric suction, parenteral fluids, antibiotics and other therapy, recurrence took place in only one instance.
"Wide acceptance of nonoperative treatment has not developed because of too frequent tragic instances of death due to continued leakage," said Dr. Berne, who is chairman and professor of the USC department of surgery.
Experience over several years has shown that leakage can be detected reliably by upper gastrointestinal x-rays in the emergency room. Oral sodium diatrizoate (Hypaque) is the contrast media used.
There is little question
Half of Perforated Ulcers Found Sealed at Admission. JAMA. 1966;198(11):43. doi:10.1001/jama.1966.03110240017010