The management of large perforations of duodenal ulcers

Perforation is the most common complication of peptic ulcer disease. In spite of modern progress in the management, it is still a life-threatening catastrophe. Due to friable margins and the moribund state of the patient, managing large duodenal perforations(>20 mm in diameter) is a challenging task. The case files of 64 patients who underwent emergency laparotomy for peptic ulcer perforations over a period of three years (2012 – 2015) were retrospectively reviewed and sorted into two groups – one group was defined as 'small 'perforations (<2 cm in diameter), another 'large' (≥2 cm). Of the total of 64 patients, there were 46 males (71.9 %). 54 patients (84.4%) came under the 'small' perforation (group A), but there were 10 patients (15.6%) with large perforation (group B). omental patch was performed in all cases in Group A. in group A, mortality rate was 3.7%. in group B, mortality rate was 60%.In 5 patients in group B, omental patch was done that mortality rate was100%. In remaining 5 patients in group B, omental plug was done that mortality rate was 20%. There are two distinct types of perforations of duodenal ulcers that are encountered in clinical practice. The first, are the 'small' perforations that omental patch closure gives the best results and have low mortality. The second are the 'large' perforations, that are uncommon, and omental plug gives the best results in this subset of patients.