title: Therapeutic management of perforated gastro-duodenal ulcer: literature review.
abstract: BACKGROUND
  Management of perforated gastro-duodenal ulcer (GDU) is not consensual, from no operative treatment to surgery by simple closure, gastrectomy and vagotomy. The purpose of this study is to report results of the literature concerning management of perforated GDU.
  
  
  METHODS
  Two authors, identified in the databases Pubmed and Embase studies, related to the therapeutic management of perforated GDU. The data were extracted from articles published between 1940 and 2012.
  
  
  RESULTS
  Non-operative treatment is feasible for patients in good general condition and in good local circumstances without evolved peritonitis with a success rate more than 50%. Simple closure is the standard method. Laparoscopy is a safe and feasible method for patient with delay of treatment less than 24 hours and without associated complications with a success (meaning non conversion) of 80% and a mortality less than 1%. Rate of conversion is 7.9%, and increases in case of ulcer size >6 mm, frail ulcer edges, bleeding associated, unusual location and septic shock. Helicobacter pylori eradication is essential. Gastric tube, abdominal irrigation and drainage are still debated. Two-stage treatment for perforated gastric carcinoma, which represents 10 to 16% of gastric perforation, is a good option for frail patients with resectable tumors.
  
  
  CONCLUSIONS
  Management of perforated GDU is still a subject of debate without guidelines but with several possibilities of treatment depending of local circumstances of peritonitis and size of defect >20 mm, general conditions, surgeon patterns and experience.
authors.affiliation: Service de chirurgie digestive oncologique et métabolique, CHU d'Amiens, place Victor-Pauchet, 80054 Amiens, France.
authors.forename: C
authors.initials: C
authors.lastname: Mouly
authors.forename: R
authors.initials: R
authors.lastname: Chati
authors.forename: M
authors.initials: M
authors.lastname: Scotté
authors.forename: J-M
authors.initials: JM
authors.lastname: Regimbeau
mesh_terms: D004381:Duodenal Ulcer / Q000150:complications / Q000601:surgery*; D019317:Evidence-Based Medicine; D005240:Feasibility Studies; D005743:Gastrectomy / Q000379:methods; D016481:Helicobacter Infections / Q000150:complications / Q000188:drug therapy / Q000601:surgery*; D006801:Humans; D010535:Laparoscopy; D018579:Patient Selection; D010439:Peptic Ulcer Perforation / Q000150:complications / Q000601:surgery*; D013276:Stomach Ulcer / Q000150:complications / Q000601:surgery*; D016896:Treatment Outcome
keywords: Gastro-duodenal perforation; Helicobacter pylori; Ulcer