Survival following perforation of peptic ulcer

Between 1979 and 1989, 92 patients were treated at St George Hospital, Kogarah, for perforated duodenal or prepyloric ulcer. Mortality rate at 28 days was 18%. Life table analysis showed 1-, 5- and 10-year survival rates for this group to be 78%, 60% and 46% respectively. During the second half of the study period, increasingly older females with a history of cardiovascular disease, arthropathy, chronic renal impairment and non-steroidal anti-inflammatory drugs (NSAIDS) intake were identified and found to be at greater risk of dying from their perforation. Age, cardiovascular disease and chronic renal impairment were demonstrated to be independent factors affecting survival. Patients treated by simple closure of the perforation had a long-term survival rate equivalent to that of patients treated in other ways, although the number of these latter patients is small. Implications for the administration of NSAIDS are considered in the light of these findings. These results suggest that orthodox simple closure of perforated peptic ulcer and administration of H2 blocking agents is the most appropriate treatment for patients presenting with perforated peptic ulcer.