Acute perforated duodenal ulcer, simple closure or definitive surgery.

บทคัดย่อ

          Base on a review of recent articles, acute duodenal ulcer perforation  should be operated on with definitive procedure, unless the patient is in poor condition on admission, in the place where patient follow up and strict medical management are lacking. It has been estimated, in this particular place, that at least two-third of the patients who are treated with simple suture will finally come back with serious ulcer complications necessitating surgical intervention. When we take natural history of the patients after simple suture into account, i.e., one—third remains asymptomatic, one-third has recurrent ulcer symptoms which need antacid treatment and another one-third requires further definitive surgery to control the disease. Selection of the patients who are aged 40 to 60 years with a history of chronic symptoms prior to perforation and less than 12 hours duration after perforation, for definitive surgery, is likely to avoid unnecessary complicated procedures for those group who further definitive operations are not needed after simple suture and best results will be obtained in term of operative mortality and complications. Once the patient survive from definitive operation, its curative and morbid effects will follow those performed in elective cases. Vagotomy and antrectomy is the procedure of choice procedure added no more disadvantage than vagotomy and drainage in this emergency situation. Although perietal cell vagotomy results, reported are too early to be accepted, theprocedure may be a compromise between conventional definitive procedures and simple closure.