Changing patterns in perforated peptic ulcer disease.

We reviewed our experience with 88 consecutive patients (49 men and 39 women) treated for perforated peptic ulcer between January 1983 and May 1988. The mean age was 61 years (range, 15-89); 63 per cent were more than 60 years of age and 44 per cent were more than 70 years of age. One third of patients had a prior history of peptic ulcer disease. Thirty-nine patients (44%) were taking ulcerogenic drugs (28 were using nonsteroidal anti-inflammatory drugs, 6 were using steroids alone, and 5 were using both). Twenty-eight patients (32%) were taking antacid/H2-blockers, including 15 patients with history of ulcer disease and 11 patients taking ulcerogenic drugs. Concurrent systemic diseases were present in 63 per cent of patients; 12 patients were hospitalized for other illnesses at the time of perforation. Abdominal pain was the chief complaint in 83 patients (94%) and 52 patients (59%) had peritonitis. Leukocytosis was present in 49 patients (56%). Pneumoperitoneum was noted in 65 per cent. The duodenal bulb was the site of perforation in 62 per cent, the pyloric region in 20 per cent, and the gastric body in 18 per cent. A definitive ulcer procedure (V + P, V + A) was performed in 32 patients (38%); 51 patients (58%) had plication, and the remaining five patients did not undergo surgery. A delay in diagnosis and therapy of less than 24 hours occurred in 20 (23%) patients. Mortality was 24 per cent, and correlated significantly with age more than 60 years, but not with treatment.(ABSTRACT TRUNCATED AT 250 WORDS)