Acute Perforation of Peptic Ulcer: What You Need to Know
Acute perforation of a peptic ulcer is a serious medical condition that requires prompt diagnosis and treatment. Once confirmed, the treatment plan typically falls into two main categories: non-surgical and surgical interventions. The choice of treatment depends on the patient's overall health, the severity of symptoms, and the duration of the perforation.
Non-Surgical Treatment Options
Non-surgical treatment is generally recommended for patients who are in good general condition and present with mild abdominal symptoms. This approach is most effective for small, fasting perforations or when the perforation has been present for more than 24 hours and peritonitis has become localized. Key components of conservative management include:
- Complete fasting and continuous gastrointestinal decompression
- Fluid and electrolyte replacement to maintain homeostasis
- Nutritional support to aid recovery
- Systemic antibiotics to control infection
- Use of acid-suppressive medications such as H2 receptor antagonists or proton pump inhibitors
During non-surgical care, patients must be closely monitored for any signs of clinical deterioration. If symptoms worsen or complications arise, immediate surgical intervention should be considered.
Surgical Treatment Approaches
When Surgery Is Necessary
Surgical treatment is typically indicated for patients with postprandial (after eating) perforations, refractory ulcers, or those who have developed complications such as pyloric obstruction, massive bleeding, or localized malignancy. The surgical options available include:
- Laparoscopic repair of the perforation
- Open surgery with simple suture repair
- Partial gastrectomy (removal of part of the stomach)
Choosing the Right Surgical Procedure
In many clinical settings, laparoscopic repair or partial gastrectomy is preferred, as these procedures can address both the perforation and underlying ulcer disease in a single operation. Patients who are in good health, have a perforation within 8 hours of onset, or have minimal peritoneal contamination are often suitable candidates for laparoscopic surgery. Meanwhile, partial gastrectomy may be recommended for individuals with chronic ulcers, especially those who have previously undergone medical therapy, or those presenting with complications like pyloric obstruction or hemorrhage.