Simple closure of perforated peptic ulcer. Still an effective procedure for patients with delay in treatment

Sixty patients (mean age, 50 years) underwent simple closure of a perforated peptic ulcer. For 56 patients, average delay in treatment was 21.6 hours. Postoperatively, 21 patients (treatment delay, 30 hours) had either pulmonary or abdominal complications. Ten patients (treatment delay, 34 hours) died. Acute onset of ulcer symptoms prior to perforation was associated with a threefold increase in mortality compared with patients with chronic symptoms. Seven patients subsequently underwent vagotomy and partial gastrectomy without complications. This study demonstrates that in patients with peptic ulcer disease, perforation is an unusually frequent indication for operation; advanced age, treatment delay of 30 hours or more, and acute ulcer symptoms are associated with increased morbidity and mortality; and simple closure of the perforation remains an effective procedure in patients who have delayed seeking treatment.