Indication of Conservative Treatment and It's Usefulness for Perforated Duodenal Ulcers

Motoaki Nagano¹⁾²⁾, Toshio Shimayama¹⁾, Nobuyasu Takahashi¹⁾, Naoya Imamura¹⁾, Kikuo Kawano¹⁾ and Kazuo Chijiiwa²⁾

Department of Surgery, Miyazaki Medical Association Hospital¹⁾
Department of Surgery 1, Faculty of Medicine, University of Miyazaki²⁾

Introduction: The purpose of this study was to evaluate the indications and usefulness of conservative treatment of perforated duodenal ulcer (PDU). Patients and Methods: A total of 80 patients with PDU between April 1997 and March 2004 were classified to a conservative treatment group and an operative therapy group, and the two groups were compared. The following criteria are generally recommended for conservative treatment: 1) generally stable condition; 2) no or only slight localized fluid collection observed by ultrasonography or computed tomography; and 3) after 1999 less than 2 cm gastrografin leakage during upper gastroduodenography (UGI) was added. Results: Among the 80 patients, 46 were initially treated conservatively, five of whom developed an abscess and 6 were converted to surgery, yielding a completion rate of 87% (40/46). The conservative treatment group was significantly younger and had shorter hospital stays than the operative therapy group. The addition of UGI was followed by there a further increase in the completion rate of the conservative treatment, and no abdominal abscesses developed. Conclusions: Our new criteria, including the UGI findings, seem useful for the indications for conservative treatment of the patients with PDU.

Key words
perforated duodenal ulcer, conservative treatment, indication, upper gastroduodenography

Reprint requests
Kazuo Chijiiwa Department of Surgery 1, Faculty of Medicine, University of Miyazaki
5200 Kihara, Kiyotake-cho, Miyazaki-gun, 889-1692 JAPAN

Accepted
December 16, 2005

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