Simple closure or definitive surgery for perforated duodenal ulcer.

In the period 1959--1971 a simple operative closure was the initial management of 112 patients with acute perforation of duodenal ulcers. At follow-up 6--18 years after perforation the relevance of the length of ulcer history prior to perforation in deciding upon 'definitive' emergency operation is evaluated. Using such a selection criterion, the rate of misinterpretation at the time of perforation is close on 50%, and half of these patients would be subjected to an apparently unnecessary operation. Furthermore, about 80% of the patients for whom simple closure was not sufficient treatment developed ulcer dyspepsia within the first year after the perforation. Therefore, simple suture of a duodenal perforation with careful clinical follow-up for at least 1 year is recommended.