'Free omental plug': a nostalgic look at an old and dependable technique for giant peptic perforations

Peptic perforation is a serious complication of peptic ulcer disease. The defect in the intestinal wall usually does not present a difficult technical problem of surgical management, in most cases perforation can be closed primarily. On rare occasions an extremely large defect (giant peptic perforation - defined as any perforation greater than 2.5 cm in size) cannot be closed by these simple techniques. Modalities of treatment advocated for such an ulcer over the years are: free omental plug in the form of a mushroom; serosal patch technique; jejunal pedicle graft, partial gastrectomy, and finally the possible addition of proximal gastrojejunostomy. The omental plug is a simple procedure which does not require expertise and can even be performed in a very short time by a trainee general surgeon in a seriously ill patient in emergency. We review 7 cases of giant peptic perforations closed by a free omental plug.