Conservative Management of Perforated Peptic Ulcer

Abstract

Objective: To determine whether surgery could be avoided in selected patients with perforated peptic ulcer.

Patients and Methods: A prospective study of the outcome of non-operative treatment in patients with a clinical diagnosis of perforated peptic ulcer was conducted. Of all 41 patients with clinical diagnosis of perforated peptic ulcer over the 3-year period, 35 were included for conservative treatment consisting of intravenous fluid resuscitation, nasogastric suction, and intravenous administration of antibiotic (Cefazolin 1 gm. IV every 6 hrs) and Ranidine 50 mg. IV every 8 hrs.

Results: Five (14%) of these 35 patients did not improve after 12 hours of conservative treatment and required an operation. All had unsealed perforation and were true failure. There was no mortality in this conservative group and no significant difference in the morbidity, such as complications or median hospital stay, between the failure group and the conservative group. Patients over 70 years old were less likely to respond to conservative treatment (P <0.05).

Conclusions: In patients with perforated peptic ulcer, an initial period of non-operative treatment with careful observation and resuscitation may be safely allowed, except in patients over 70 years old, and that the use of such an observation period can obviate the need for emergency surgery.