Perforated duodenal ulcer in elderly patients

To examine the mortality and morbidity associated with perforated duodenal ulcer in patients 70 years or older a review of those admitted between 1978 and 1987 was undertaken. There were 33 patients, three in whom the diagnosis was made at post-mortem examination. Two patients were considered unfit for surgery and were treated conservatively while 28 were treated by operation. There were three postoperative deaths giving an operative mortality rate of 11.7%. Overall mortality rate from perforated duodenal ulcer in the series was 24%. Serious postoperative morbidity occurred in 72% of patients surviving operation. The occurrence of morbidity correlated positively with the time interval between symptoms of perforation and surgery although statistical significance was not shown. Perforated duodenal ulcer is associated with a high mortality and morbidity in the elderly. Efforts to reduce mortality and morbidity should be aimed at accurate diagnosis and early surgical intervention.