Perforated Gastroduodenal Ulcer (PGDU)

Abstract

Perforated gastroduodenal ulcers (PGDU) refer to a spontaneous perforation of the gastric or duodenal wall associated with free air (on imaging), localized or generalized peritonitis with or without associated sepsis. The condition is associated with increased mortality with increasing delay to diagnosis, delay to surgery, as well as in the elderly and in the comorbid patients. The mortality rate in perforated gastroduodenal ulcers (PGDU) remains high, reported from 10 to 30%, with notable geographic differences. Outcome is related to age, presence of comorbidity and strongly linked to delay in diagnosis and treatment. CT is the preferred modality for imaging due to the superior accuracy. Surgical repair can be done as open or laparoscopic, with no differences in major outcomes. Reoperation rates are reported at 15–20% and most often due to leaks. For patients not improving after surgery, a persistent leak or intra-abdominal collection should be suspected and aggressively diagnosed and managed, either percutaneously (collections) or by reoperation (leaks). Here we outline key standards and develop measurement KPIs for emergency surgery for perforated gastroduodenal ulcers. The focus is set on timing of diagnosis, timing of surgery, mortality, reoperation rates and use of laparoscopy.