The management of perforated peptic ulcer entails:
patient is made nil by mouth
analgesia - i.m. pethidine
antiemetic - i.m. prochlorperazine
treatment is usually surgical:
the duodenal ulcer is oversown either at open laparotomy or laparoscopically:
when perforation and bleeding occur simultaneously, a Billroth II partial gastrectomy is advisable
the gastric ulcer, due to its tendency in one third of cases to be malignant, and also because of an increased tendency to breakdown after repair, is usually treated with a partial gastrectomy; simple oversewing may be contemplated when the ulcer is:
close to the pylorus
due to steroids or stress
when the patient is in extremis
rarely, a perforation may become walled-off by fibrin and omentum, conservative management with nasogastric suction is instituted, and the patient improves without recourse to surgery
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