Duodenal perforation simple closure or definitive surgery in emergency laparotomy

ABSTRACT

Perforated peptic ulcer, an emergency, continues to afflict large number of population. Males are affected more than females. There is close association with Helicobacter pylori and NSAID's ingestion. Duration of perforation > 12 hours, systolic blood pressure less than 100 mm Hg and co morbid conditions are the risk factors. Controversy exists regarding simple closure or definitive surgery in emergency setting. This prospective study was conducted at CMH, Rawalpindi from July 2000 to Dec 2001. 46 males, alternatively allocated to two groups received either simple closure with omental patch or truncal vagotomy with drainage procedure. Risk factors were stratified into scoring system. Patients were followed up and results graded as modified Visick's classification. There was no mortality with risk score 1 or 2 in both groups. 66.6% mortality in group - I and 100% mortality in group - II with risk score 3 was noted. Excellent / good results were obtained in 52.3% of cases undergoing simple closure versus 85% undergoing definitive surgery