Management of acute gastroduodenal perforations

Abstract

C HANGING concepts of the course of peptic ulcer disease together with advances in supportive therapy have stimuIated continued interest in the management of acute gastroduodenal perforations. During the past decade three main trends in the therapy of this emergency have received attention: (I) simpIe suture of the perforation, (2) immediate subtotal gastrectomy or (3) non-operative treatment with antibiotics and continuous gastric suction. Each of these methods has its proponents who, in supporting their own particuIar therapeutic inn it may be that the apparent recent increase in the incidence of perforated uIcer in older age groups is a manifestation of a genera1 increase in the average age of patients hospitaIized in city institutions. The average age of incidence reported is generaIIy between forty and fifty years. Our findings emphasize that perforated peptic uIcer is by no means a disease of young adults but aIso must be considered strongIy when a patient from the middIe or oIder age groups presents an acute abdomina1 probIem. In the recent series 84 per cent of the patients presented a history of previous symptoms suggestive of peptic uIcer disease, whereas in 16 per cent perforation was the first indication of the presence of the ulcer. The tabIe shows that there has been a decided decrease in the proportion of patients without an uIcer history prior to perforation. It is interesting to note that a11 of the femaIe patients gave a past history of epigastric distress whereas 18 per cent of the maIe patients had had no previous