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- Title
Management Of Perforated Peptic Ulcers.
- Authors
Salah, Emad Mohammed; Alnaimy, Tamer Alsaied; Atwa, Atwa Arafat; Osman, Gamal Mohamed
- Abstract
Background: In conjunction with the diagnosis,, an effective initial resuscitation should be done, and a management plan should be established. It should be noted that delayed presentation, hemodynamic instability, and preexisting co-morbidities necessitates aggressive resuscitation prior to surgery and close perioperative monitoring; to minimize the subsequent morbidity and mortality related to the condition, proper management plan regarding the treatment options of the perforation alone or addition of an ulcer definitive surgery should be addressed to each patient according to his condition. Conservative treatment is known as the Taylor method and consists of nasogastric aspiration, antibiotics, IV fluids, and Helicobacter pylori triple therapy. In 1946 Taylor presented the first series of successfully outcome of conservatively treated patients with perforated peptic ulcer, based on the theory that effective gastric decompression and continuous drainage will enhance self-healing. The idea for conservative treatment came from Crisp who in 1843 noted that perforations of the stomach were filled up by adhesions to the surrounding viscera which prevented leakage from the stomach into the peritoneum. But still there is an ongoing debate whether perforated peptic ulcer generally needs to be operated on or not. Many techniques have been described in the literature for the surgical treatment of perforated peptic ulcers starting from simple closure of the perforation with an omental patch, using an omental plug, a falciform ligament patch, a serosal jejunal patch and even proceeding to resection of perforation bearing duodenum and the antrum in the form of a partial gastrectomy with either a Billorth I or Billorth II anastomosis for larger perforations. Most of these techniques can be achieved using the open or the laparoscopic approaches.
- Publication
Journal of Pharmaceutical Negative Results, 2022, Vol 13, p4334
- ISSN
0976-9234
- Publication type
Article
- DOI
10.47750/pnr.2022.13.S07.542