2006 Volume 26 Issue 7 Pages 845-850
Conservative treatment for acute perforated gastric or duodenal ulcers was evaluated using a clinical pathway (CP). Fifteen days was set as the admission period for our CP, with the first three days under intensive care unit (ICU) management. This CP was applied to a total of 34 patients between October 2000 to June 2006 with the following results: 29 patients were treated successfully without variance, yielding a completion rate of 85.3% (29/34); the treatment of 5 patients deviated from the CP; two cases developed intra-abdominal abscesses, two cases were diagnosed as having of malignant gastric disease as a result of endoscopic examinations performed on the 7th admission day, and one case was diagnosed as having an unclosed perforated duodenal ulcer as a result of an endoscopic examination performed on the 7th admission day, resulting in conversion treatment to surgical treatment. Based on the previously mentioned results, we set the entry criteria for the CP as follows: 1) an age less than 65 years; 2) no evidence of psychiatric diseases; 3) no or only a small amount of ascitic fluid collection; 4) no apparent history of cancer or severe underlying disease and a generally stable condition. We concluded that conservative treatment for acute perforated gastric or duodenal ulcer using our CP was effective from both a medical and an economic viewpoint in the majority of patients who met the entry criteria.
