Treatment Options for Perforated Duodenal Ulcer

Perforated duodenal ulcers require prompt and appropriate treatment depending on the severity of the condition and the patient's overall health. The treatment approach can be broadly categorized into conservative and surgical methods, each suitable for different clinical scenarios.

Conservative Treatment

For patients with a small, fasting perforation and minimal symptoms, non-surgical management may be considered. This typically involves gastrointestinal decompression, administration of antibiotics to prevent or manage infection, and the use of acid-suppressing medications such as proton pump inhibitors (PPIs) to promote ulcer healing. In addition, protective agents for the gastric mucosa may be prescribed. With proper care, many patients experience ulcer healing without the need for surgery.

Surgical Treatment

1. Perforation Repair

Perforation repair is currently the most commonly used surgical procedure due to its simplicity and effectiveness. During the operation, the surgeon closes the perforation using sutures and often covers the area with an omental patch to reinforce the repair. The abdominal cavity is then irrigated and drained to prevent infection. This method offers a relatively short recovery period and causes less physical stress to the patient. After surgery, it is recommended that patients continue medical therapy under the supervision of an internal medicine specialist to treat the underlying peptic ulcer disease.

2. Subtotal Gastrectomy

In the past, subtotal gastrectomy was a frequently performed procedure for treating duodenal ulcers. However, due to advancements in medical therapy and the significant impact of gastrectomy on a patient's quality of life, this approach is now less commonly recommended. It is typically reserved for cases where the perforation is extensive, there is severe peritonitis, or other complications are present that make simpler repair techniques unsuitable.

When Surgery is Necessary

If the ulcer has caused a large perforation, severe abdominal infection, or significant clinical symptoms, surgical intervention becomes essential. Prompt diagnosis and treatment are crucial to prevent life-threatening complications such as sepsis or shock.