Kane E, Fried G, McSherry C K
J Am Geriatr Soc. 1981 May;29(5):224-7. doi: 10.1111/j.1532-5415.1981.tb01771.x.
From 1973 through 1979, 32 patients over 60 years of age were admitted to the Beth Israel Medical Center, New York, because of a perforated gastric or duodenal ulcer. In many of them, the symptoms and physical findings were minimal. In abdominal roentgenograms (subject erect or supine), only 17 (60 percent) of these patients showed free intraperitoneal air. Among the 29 surgically treated patients, plication of the ulcer was performed in 28 and hemigastrectomy-vagotomy in one. The postoperative morbidity rate was 62 percent, and the mortality rate 17 percent. In 3 of the 32 patients, the diagnosis of perforated ulcer was established only at autopsy. Thus, failure to diagnose this condition accurately may be the principal cause of death in elderly patients with a perforated peptic ulcer. The increased use is recommended of contrast roentgenograms of the stomach and duodenum and of endoscopy, in an effort to improve diagnostic accuracy in dealing with perforated peptic ulcers.
1973年至1979年期间，32名60岁以上的患者因胃或十二指肠溃疡穿孔入住纽约贝斯以色列医疗中心。他们中许多人的症状和体格检查结果很轻微。在腹部X线片（患者直立或仰卧）中，这些患者中只有17例（60%）显示有游离腹腔内气体。在29例接受手术治疗的患者中，28例行溃疡折叠术，1例行半胃切除迷走神经切断术。术后发病率为62%，死亡率为17%。32例患者中有3例仅在尸检时才确诊为溃疡穿孔。因此，未能准确诊断这种情况可能是老年消化性溃疡穿孔患者死亡的主要原因。建议增加胃和十二指肠造影X线片及内镜检查的使用，以提高处理消化性溃疡穿孔的诊断准确性。
