The purpose of this study was to evaluate the risk factors influencing the short-term results of gastroduodenal perforation to determine the optimal treatment for reducing mortality. A total of 136 patients were retrospectively reviewed and the prognostic factors were examined. Seven patients died within 30 days, with an overall mortality rate of 5.1%. Mortality was significantly worse in those aged 50 years or more, when the leukocyte count was less than 9,500/mm3, when treatment was delayed more than 12h after perforation, in cases of preoperative shock and renal failure, and when associated with liver cirrhosis or an immunocompromised state. Tolerance to the time delay was inversely proportional to age, while the deaths in patients aged 65 years or younger were related to serious concurrent diseases. Shock and renal failure occurred most often in elderly patients as a result of delayed surgery, and the leukocyte count was an age-dependent prognostic indicator. Thus, age, the time interval between perforation and treatment, serious concurrent disease, shock, and renal failure were presumed to be the most important prognostic factors. Although definitive operations were performed on low-risk patients with an acceptably low mortality, it remains to be determined whether simpler procedures should be adopted for high-risk patients.

Occasionally, a preduodenal portal vein (PDPV) is found in pediatric patients with intestinal obstruction due to duodenal compression. In adults, it is often symptom-less and is an exceptionally rare condition. It is of surgical importance, however, because the vein lies in the most superficial position ventral to the common bile duct and is easily damaged during operations involving the biliary tract and duodenum. We recently treated a patient with PDPV, which stimulated a review of the disease process, including diagnosis, association with other anomalies, and surgical treatment.

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