All perforated ulcers are not alike

To determine if ulcer location and other clinical factors affect the hospital course and early outcome of patients with perforated peptic ulcers in the decade since the introduction of H2 receptor antagonists, the records of 80 patients with perforated peptic ulcers were analyzed. Demographic factors, clinical features, and the outcome of patients with duodenal ulcer perforation were similar to patients with prepyloric ulcer perforation. In contrast, patients with gastric ulcer perforation had differing characteristics from the group with perforated pyloroduodenal ulcers. Overall, NSAID use preceded perforation in one half of the patients; severe coexisting medical illness and a short interval of symptoms before perforation were seen in more than one half of patients. Gastric ulcer location, hemodynamic instability, greater degree of peritoneal contamination, and larger ulcer size were factors associated with increased rates of mortality. Overall mortality rate was 12.5% and rate of morbidity was 33%. Oversewing with or without omental patch was the operation most commonly employed by a diverse group of surgeons.