Treatment Options for Perforated Duodenal Ulcer

A perforated duodenal ulcer is a common and serious medical emergency. It develops rapidly and can be life-threatening if not treated promptly. The condition requires immediate medical attention to prevent complications such as severe peritonitis or sepsis. Treatment options are generally divided into two categories: surgical and non-surgical approaches, depending on the patient's overall condition and the severity of the perforation.

Surgical Treatment Approaches

Surgery is often the preferred method for treating a perforated duodenal ulcer, especially in more severe cases. There are two primary types of surgical procedures. The first is a simple closure or suture of the perforation. This method is typically recommended when the ulcer has been present for more than 8 hours, there is significant infection in the abdominal cavity, or the patient has other underlying health conditions that make a longer operation risky. Since duodenal ulcers are generally benign, this approach offers a quick solution with lower immediate risk.

Radical Surgical Procedures

In most cases, especially when the patient is stable and the perforation has occurred within the last 8 hours with minimal abdominal contamination, a more comprehensive procedure such as a partial gastrectomy may be performed. This approach not only repairs the perforation but also removes the ulcer itself, addressing both issues in one operation. This method helps reduce the risk of recurrence and is considered a long-term solution for patients with severe ulcer disease.

Non-Surgical Treatment for Specific Cases

Non-operative treatment may be considered under certain conditions. Patients who present with minimal symptoms, localized peritonitis after more than 24 hours, or those who have undergone imaging studies such as water-soluble contrast studies (e.g., gastrograffin) that confirm the perforation has sealed may be candidates for conservative management. This option is also suitable for individuals without complications such as bleeding or pyloric obstruction.

Key Components of Non-Surgical Management

Non-surgical treatment involves several critical interventions aimed at stabilizing the patient and promoting healing. These include continuous gastric decompression using a nasogastric tube, maintaining fluid and electrolyte balance, and providing adequate nutritional support. Additionally, intravenous antibiotics are administered to control infection, and proton pump inhibitors (PPIs) are used to suppress gastric acid secretion, which helps promote ulcer healing and prevent further complications.