2003 Volume 23 Issue 6 Pages 859-864
The purpose of this study was to evaluate the indications and effectiveness of conservative treatment forperforated duodenal ulcers. The following criteria for perfoming conservative treatment for perforatedduodenal ulcers were prospectively applied to cases from April, 1996 to Octover, 2002: 1) no severeunderlying disease and a generally stable condition; 2) localized peritonitis (peritoneal signs limited to theupper abdomen); 3) no or a small amount of ascitic fluid collection determined by ultrasonography orcomputed tomography; and 4) within 12 hours after the onset of perforation. Twenty-seven cases met thecriteria, and of these, twenty-five were treated successfully. In a all patients, the presence of a perforatedduodenal ulcer was confirmed by endoscopic examination on admission. A delayed emergency operationwas performed in two cases. In one case, muscle guarding and peritoneal signs persisted 24 hours afteradmission and laparoscopic surgery was performed. However, the operative findings revealed that theperforation site was already sealed, which indicated that surgery was not needed in this particular patient.In another case, surgery was performed 12 hours after admission because of progression of peritoneal signs, decreased WBC to 2, 500, increase in ascitic fluid and development of acidosis. We conclude that conservativetreatment is effective for the majority of patients with perforated duodenal ulcers under the criteriashown above with careful observation.
