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Management

Authoring team

The management of perforated peptic ulcer entails:

  • patient is made nil by mouth
  • analgesia - i.m. pethidine
  • antiemetic - i.m. prochlorperazine

  • treatment is usually surgical:
    • the duodenal ulcer is oversown either at open laparotomy or laparoscopically:
      • when perforation and bleeding occur simultaneously, a Billroth II partial gastrectomy is advisable
    • the gastric ulcer, due to its tendency in one third of cases to be malignant, and also because of an increased tendency to breakdown after repair, is usually treated with a partial gastrectomy; simple oversewing may be contemplated when the ulcer is:
    • close to the pylorus
      • due to steroids or stress
      • when the patient is in extremis

  • rarely, a perforation may become walled-off by fibrin and omentum, conservative management with nasogastric suction is instituted, and the patient improves without recourse to surgery

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