Selective surgical management of perforated duodenal ulcer.

In an effort to clarify the preoperative indications and factors predisposing to an increased operative morbidity for "definitive" ulcer procedures, the medical records of 114 patients with perforated duodenal ulcers were reviewed. One hundred nine patients underwent operation, with 55 patients treated with ulcer closure (Group 1) and 54 underwent a "definitive" operation (Group 2). Thirty-two complications developed in 27 patients (25%), with major infectious complications occurring in 9 per cent and 7.5 percent in the simple ulcer closure and definitive surgery groups, respectively. This study demonstrates that preoperative shock, operation delayed greater than 48 hours, and patient age greater than 60 years were significant factors increasing morbidity. The importance of peritoneal soilage and positive cultures are unreliable in predicting subsequent clinical infection and do not contraindicate definitive surgical management.