Perforated duodenal ulcer in the elderly.

In a 10-year retrospective review of 41 patients aged greater than or equal to 65 years and treated for perforated duodenal ulcer, an attempt was made to characterize the clinical and laboratory profile and evaluate treatment policy for this surgical emergency in the elderly. In 1/3 of the series no accurate history was obtainable. Peroperative findings were sometimes discordant with laboratory data. Vagotomy and drainage were performed in ten low-risk patients and simple closure with omentopexy in 26. Conservative treatment was employed in four patients, three of whom recovered while one later required closure. Gastroenterostomy was performed in one case. A patient with severe mesenteric thrombosis had no perforation-related surgery. Vagotomy and drainage were associated with significantly fewer complications and shorter hospital stay than simple closure, no mortality (vs. 8%) in closure) and only one recurrence during follow-up averaging 37 months. This small, non-randomized series does not permit conclusive recommendations, but the data advocate definitive surgery in properly selected cases and stress the importance of associated pathology for decisions on treatment.