A non-operative treatment of perforated peptic ulcer: A prospective study with 50 cases

Background and Objectives: Perforation remains a major life threatening complication of peptic ulcer disease. Surgery has been the conventional treatment for it. The results of the surgery are excellent, but they are associated with morbidity and mortality. Wangensteen, in 1935 and Taylor, in 1946 have shown that a non-operative treatment is safe and effective in selected patients because the peptic perforations frequently get sealed spontaneously by the omentum and the adjacent organs. We undertook a prospective study to evaluate the results and to assess the feasibility of a non-operative treatment for perforated peptic ulcers. Materials and Methods: This prospective case series study was carried out at the AJ Medical College, Mangalore, Karnataka, India, from Dec 2009 to Dec 2011.We studied 50 cases with a clinical diagnosis of perforated peptic ulcer. The inclusion criteria were a clinical diagnosis of perforation in less than 12 hours with a stable haemodynamic condition, age -20-70 years and a X-ray and/or a CT evidence of a pneumoperitoneum. The conservative management consisted of nil by mouth, nasogastric suction, IV fluids, intravenous antibiotics and IV Omeprezole. Results: Out of the 50 cases, 41 (82%) cases responded well, while the remaining 9 cases failed to improve and they required emergency laparotomy. 11 of the 41 cases in the successful group developed complications, which were managed successfully and they didn't prolong their hospital stay. The conservative management didn't increase the morbidity significantly. Conclusion: We conclude that the conservative treatment for perforated peptic ulcer can be safely adopted in selected patients, provided strict inclusion criteria and guidelines are followed.