Perforated Duodenal Ulcer

Simple Closure or Vagotomy and Pyloroplasty for the Treatment of a Perforated Duodenal Ulcer: Comparison of Results

“…Accepted that the simple closure of the perforation is the chosen treatment of a perforated duodenal ulcer for old people [8], for acute ulcer produced by the taking of NSAIDs, and in the high-risk patient [9, 10], we can go on to say that the nonexistence of a satisfactory agreement about the function H. pylori exercises in the etiology of the perforation [11, 12], the seriousness of the ulcer [13, 14], this meaning having ulcerous symptoms for at least 3 months before the perforation, and the high recurrence rate after the simple closure, are the main causes of dissension regarding which surgical technique to use, and the reason for diagnosing a definite surgical treatment in the perforated chronic duodenal ulcer [15, 16, 17]. …”

Perforated Peptic Ulcer Disease: A Review of History and Treatment

“…The type, number of drugs given and treatment duration differ enormously [25]. Although the problem of antibiotic resistance of H. pylori is increasing, combination therapies such as metronidazole with clindamycin or metronidazole with tetracycline can achieve eradication rates of 80% or more [19,26]. According to the Maastricht III consensus report, first line treatment for H. pylori infection should be triple therapy which should compromise a proton pump inhibitor (PPI) plus clarithromycin plus amoxicillin or metronidazole [17,27].…”

“…Conservative treatment is known as the Taylor method and consists of nasogastric aspiration, antibiotics, intravenous fluids and nowadays H. pylori triple therapy [23,26]. In 1946, Taylor presented the first series of successful outcome of conservatively treated patients with PPU, based on the theory that effective gastric decompression and continuous drainage will enhance self-healing [9,26].…”

“…In 1946, Taylor presented the first series of successful outcome of conservatively treated patients with PPU, based on the theory that effective gastric decompression and continuous drainage will enhance self-healing [9,26]. The fundamental idea for conservative treatment came from Crisp who in 1843 noted that perforations of the stomach were filled up by adhesions to the surrounding viscera which prevented leakage from the stomach into the peritoneum [26]. Since then, many reports have been published on this topic, with different success rates [9].…”

“…But still there is an ongoing debate whether PPU generally needs to be operated on or not. It has been estimated that about 40–80% of the perforations will seal spontaneously and overall morbidity and mortality are comparable [19,23,26,28]. However, delaying the time point of operation beyond 12 h after the onset of clinical symptoms will worsen the outcome in PPU [9,19].…”