management
Last reviewed 01/2018
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