There are 3 possible types of therapy for the acutely perforated duodenal ulcer: simple operative closure, emergency gastric resection, and nonoperative management. A review of the literature for the past decade shows an increasing note of pessimism regarding the time-honored simple operative closure primarily because of the mortality rate, which still remains near 25% in many recent series. Secondarily, dissatisfaction is based on the fact that about a third of the patients come to gastric resection later. This is used as an argument in favor of routine emergency gastric resection. In most reports, nonoperative management is reserved for those patients who refuse surgery, those who are too ill to survive any operative procedure, or those who suffered their perforation many hours before hospitalization and are improving at the time they are first seen. This means, in actuality, that the non-operative management never is a deliberate choice but represents what
BOWERS WF, GEER TM, HUGHES CW. Perforated Duodenal Ulcer: Results of Individualized Surgical Care. Arch Surg. 1961;82(2):293–297. doi:10.1001/archsurg.1961.01300080121010
Customize your JAMA Network experience by selecting one or more topics from the list below.
Create a personal account or sign in to: