Evaluation of Early Resumption of Dietary Intake in Patients Treated with Conservative Therapy for Gastric or Duodenal Perforation

Abstract

The purpose of this study was to evaluate the safety and usefulness of our protocol including the early resumption of dietary intake on day 4 of hospitalization in patients treated with conservative therapy for gastric or duodenal perforation. Patients were allowed to resume dietary intake on day 4 provided they had no symptoms of peritoneal irritation or delayed fever, and without any upward tendency of their white blood cell count. In 28 patients treated conservatively for upper gastric perforation, the timing of dietary intake resumption was on day 4 of hospitalization (median), and 21 of those (75％) were allowed to resume dietary intake on day 4, following exactly our protocol. Two of the 28 needed conversion from conservative to surgical treatment, however, only one required conversion after starting dietary intake. Intraabdominal abscess formation was seen in two patients, but both were treated with antibiotics and drainage. The median hospital stay was 8 days which was much shorter than previous reports, and no death was seen. Consequently, resuming dietary intake on hospital day 4 is useful in shorting the hospital stay without increasing complications such as failure of conservative therapy and intraabdominal abscess formation.