Natural history of perforated duodenal ulcers treated by suture closure

Of 50 patients with a perforated duodenal ulcer treated with simple suture closure, 36 (72%) had symptoms before the perforation for a mean period of 9.9 years. 24 of the 36 (66.6%) acquired further symptoms or complications at 1--48 months (mean 11 months) after the operation, whereas only 2 of the 14 patients (14%) who were symptom-free preoperatively had further complications. At follow-up 48% of the patients were still free of symptoms. Simple suture closure with a "wait and see" policy remains the treatment of choice, and a prospective clinical study to evaluate definitive emergency surgery for duodenal ulcer has been cancelled.