[Perforated peptic ulcer. Immediate results of therapeutic strategy]

The aim of this study was to evaluate of logical program for the management of patients with perforated peptic ulcers. The case records of 75 consecutive patients were reviewed. The average age of the patients was 52 years. Ten patients were older than 80. The logical program was based on preoperative risk factors (concurrent medical illness, preoperative shock, and longstanding perforation more than 48 hours), history of chronic ulcer symptoms, and in selected cases, spontaneous seal on X-Ray gastroduodenogram with a water soluble contrast medium. The program was applied in 75% of cases and not applied in 25%. Out of 9 post-operative deaths (12%), 3 had a surgical cause: leakage of the suture with dehiscence in two cases. The mortality increased progressively with increasing of number of risk factors: 0%, 10% and 55% in patients with no, one, and two or three risk factors respectively. These findings constitute a validation of the predictive factors of death proposed by Boey et al. A logical program for the management of patients based on results of such multifactorial studies on risk factors, and on results of randomized prospective controlled studies may be applied in almost all patients. Our results also suggest that the quality of the perforation suture, and of the abdominal closure, especially in old and obese patients, are the most important factors to decrease the mortality.