[Perforated gastroduodenal ulcers. Treatment by peritoneal dialysis. 72 cases]

Seventy-two perforated gastroduodenal ulcers were treated by an original method aimed at avoiding emergency surgery, which consists of peritoneal dialysis associated, during 3 days, with gastric aspiration. Over a 3-year period this method was applied to all patients admitted with a perforated ulcer. The ulcer was revealed by the perforation in 25 p. 100 of the cases, and 90 p. 100 of the patients had pneumoperitoneum. Contrast radiography with Gastrografine (sodium and meglumine amidotrizoate) located the perforation. Fifteen patients had another disease which made the prognosis worse. The time elapsed between perforation and treatment was 15 hours on average. Peritoneal fluid infection was present in 30 p. 100 of the cases. The outcome was favourable in 69 patients (96 p. 100). One patient died of pulmonary embolism, another was operated upon on the 4 th post-perforation day for a bleeding ulcer and a third patient with giant gastric ulcer developed subphrenic abscess. This method seems to be indicated in patients at high surgical risk (elderly people or people with severe underlying disease), and in young patients with perforated acute ulcer. In chronic ulcers, peritoneal dialysis ties the patient over the first hours, thus enabling radical surgery to be electively performed. In perforations seen after 24 hours, it helps in supporting the patient prior to surgery. The method in contra-indicated in gastric ulcers.