Perforated peptic ulcer--the changing scene.
There is a changing scene with perforated peptic ulcer. The older age of presentation, the increased association with non-steroidal anti-inflammatory drugs, associated increased debility, and resulting higher mortality in the elderly, are causing a rethink in management protocols. Whereas years ago most discussion was on whether urgent definitive surgery was the most effective therapy, nowadays there is a tendency to less invasive measures. A 'deliberative' approach, wherein not all patients require surgery, is detailed, and there may be an increasing role for laparoscopic perforation-sealing techniques in the remainder. Anti-secretory and anti-helicobacter drugs have an important role in post-operative care following lesser procedures than definitive surgery.
Department of General Surgery, Box Hill Hospital, Melbourne, Australia.
J R
JR
Cocks
D000328:Adult; D000367:Age Factors; D000368:Aged; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000009:adverse effects; D016481:Helicobacter Infections / Q000150:complications; D016480:Helicobacter pylori; D006635:Histamine H2 Antagonists / Q000627:therapeutic use; D006801:Humans; D008875:Middle Aged; D010439:Peptic Ulcer Perforation / Q000209:etiology / Q000601:surgery / Q000628:therapy*; D012307:Risk Factors; D013276:Stomach Ulcer / Q000150:complications
D000894:Anti-Inflammatory Agents, Non-Steroidal; D006635:Histamine H2 Antagonists