Surgical treatment of drug-induced gastroduodenal perforations

The optimum method of managing perforated peptic ulcers remains controversial, particularly when associated with the ingestion of ulcerogenic drugs. We reviewed the notes for a series of patients treated surgically by simple closure of drug-induced peptic ulcer perforations to identify whether simple closure and omental patching alone was an effective treatment in these patients. We also wrote to their primary care physicians to obtain details of any further dyspeptic symptoms, continued ulcerogenic drug use, or the need for further antiulcer therapy or surgery. Thirty patients underwent simple closure and omental patching. The overall mortality rate was 27% but increased to 38% in patients older than 80 years. Aspirin was implicated in perforations in only seven cases, and steroids alone were not implicated in any cases. Eight patients have subsequently restarted ulcerogenic drugs without further dyspeptic symptoms. We conclude that simple closure is a safe and effective means of treating perforated peptic ulcers associated with ulcerogenic drugs, even if these are restarted.