Emergency vagotomy and pyloroplasty for perforated duodenal ulcer: study of 73 cases

The treatment of perforated duodenal ulcer

The prognosis of 189 patients with a perforated duodenal ulcer was analysed. There were three treatment groups, non-operative, simple closure and definitive ulcer surgery. The prognosis of the patients was analysed in terms of the chronicity of the ulcer. Perforations occurring in acute duodenal ulcers have an excellent prognosis, with similar results in each group in this series. All perforations of chronic duodenal ulcers should be treated by emergency surgery.

Treatment and mortality of perforated peptic ulcer: a survey of 852 cases

All proved cases of perforated peptic ulcer occurring in the Greater Vancouver area during the decade 1959-1968 have been studied. The incidence of perforation was approximately 10 per 100,000 population. The mean age was 55 years and the peak age incidence was in the fifth decade. The site of perforation was pyloroduodenal in 88% of cases and simple closure was the treatment employed in 81%. The overall mortality rate was 18.3% and one-third of these fatalities were due to misdiagnosis. The operative mortality rate was 9%.The overall mortality rate was significantly greater among women and the elderly, in gastric perforations, and in perforations occurring between 11 p.m. and 8 a.m.A close correlation was found between operative mortality rate and the time interval between perforation and operation. This elapsed time was found to be significantly greater among women and the elderly, in gastric perforations and in perforations occurring during the night.

Perforated peptic ulcer in the Vancouver area: a survey of 852 cases

A total of 852 perforations of peptic ulcers occurring in the Greater Vancouver area during the decade 1959-1968 have been studied. The incidence of perforation has declined during this period owing to a decrease in the number of perforations occurring in males. The incidence of perforation was similar to that in the South of England and New Zealand (approximately 10 per 100,000 population) but less than half that reported from Scotland.The sex ratio of 3.6 males to 1 female was similar to that found in other countries. The mean age of the males was 53.9 years and of the females 56.5 years. The peak incidence occurred in the decade 40 to 49 years. Patients with gastric perforations were significantly older than patients with pyloroduodenal perforations.Perforation occurred most frequently in the late afternoon, on Wednesday and during December; least commonly during the night, at the beginning of the week and through September.The pyloroduodenal was the commonest site of perforation (88%) and the usual treatment was simple closure (81%). The overall mortality rate was 18.3% and one-third of all fatalities were due to misdiagnosis. The operative mortality rate was 9%.