Non - operative management of perforated peptic ulcer

ABSTRACT

The aim of this study was to see the morbidity and mortality in peptic ulcer perforation cases by non-operative management in selected cases. Design: The cases were selected on the basis of structured protocol. Setting: This study was carried out in the Department of Surgery of Khulna Medical College Hospital located in southern Bangladesh over a period of 10 years. Subjects: The patients were diagnosed as perforated peptic ulcer clinically and radiologically. All patients in this series had pneumoperitoneum in plain x-ray abdomen. They included 54 patients of peptic ulcer perforation cases had the following parameters early presentation [<12 hours], soft abdomen with minimum tenderness and relatively younger patients. All patients were chosen who were haemodynamically stable. Ultrasonography was done in doubtful cases and also to see the amount of free fluid inside the abdominal cavity. Methodology: After diagnosis, all patients were managed in a similar fashion-like nil by mouth, continuous gastric aspiration, application of intravenous fluids and antibiotics and antiulcer therapy. In the selected 54 patients, male female were 4905. Nine had history of NSAID intake. There was no mortality. Morbidity analysis showed that three had hepatic abscess, four had pelvic abscess, six took prolonged time for improvement, in two cases conservative treatment had to be abandoned and laparotomy was done in the same hospital admission. Non-operative procedure is a safe and effective measure for the management of perforated peptic ulcer in selected cases