Non-operative management of perforated duodenal ulcer

We describe the selective non-operative management of 34 patients who had a n initial diagnosis of perforated duodenal ulcer made on acute presentation between 1984-1994 in our district surgical unit. Diagnosis of the conditio n was made on clinical grounds with the aid of an erect chest X-ray which d emonstrated pneumoperitoneum in 28 patients (82 per cent). Six patients (18 per cent) who did not respond to non-operative treatment required surgical intervention; 3 patients had an unsealed duodenal ulcer perforation; 2 had a perforated benign gastric ulcer and 1 patient had acute gangrenous chole cystitis, The overall mortality and morbidity rate was 3 per cent and 35 pe r cent respectively. There were no documented reperforations over a mean fo llow-up period of 27 months. While these figures are acceptable and compara ble with operative intervention for this condition, we do however stress th e labour intensive methods and close clinical monitoring that is required t o avoid morbid sequelae.