Acute Perforation Of Gastric And Duodenal Ulcers: What You Need To Know

Acute perforation of gastric and duodenal ulcers is a serious medical condition that requires prompt diagnosis and treatment. Once diagnosed, the appropriate course of action typically falls into one of two categories: non-surgical management or surgical intervention. Each approach has specific indications and benefits depending on the patient's overall health and the severity of the condition.

Non-Surgical Treatment Options

Non-surgical treatment is often considered for patients who are in relatively good health and exhibit mild abdominal symptoms. This approach is particularly suitable for individuals with small, fasting-related perforations or those who have had a perforation for more than 24 hours, where peritonitis has become localized.

Key components of non-surgical treatment include fasting, continuous gastrointestinal decompression to prevent further leakage of gastric contents, fluid and electrolyte replacement, and nutritional support. Additionally, broad-spectrum antibiotics are administered to control infection, while medications such as H2 receptor antagonists or proton pump inhibitors are used to suppress gastric acid secretion.

Close monitoring is essential during conservative management. If symptoms continue to worsen despite these measures, immediate surgical intervention becomes necessary to prevent life-threatening complications.

Surgical Intervention

When Surgery Is Required

Surgery is typically recommended for patients who experience perforation after a heavy meal, those with refractory ulcers, or those who develop complications such as pyloric obstruction, severe hemorrhage, or local malignancy. In such cases, surgical repair offers a more definitive solution.

Available Surgical Procedures

Common surgical options include laparoscopic repair of gastric and duodenal perforations, open simple suture repair, and partial gastrectomy. Among these, laparoscopic surgery is often preferred due to its minimally invasive nature and ability to address both the ulcer and perforation in a single procedure.

Partial gastrectomy is particularly beneficial for patients in good general condition, especially when the perforation occurred within the last 8 hours or when peritoneal contamination is not extensive. This procedure is also considered for patients with a history of chronic ulcers, including those who have previously undergone medical treatment, or those presenting with complications such as pyloric obstruction or gastrointestinal bleeding.