A Prospective Study of Operative Risk Factors in Perforated Duodenal Ulcers

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Abstract
Operative risk factors for patients with perforated duodenal ulcers were examined prospectively in 213 operated patients. Nine hospital deaths (4.2%) resulted from respiratory failure, sepsis and bleeding. Complications (45) developed in 27 patients (12.7%). Concurrent medical illness, preoperative shock and longstanding perforations (> 48 h) were significant features that increased mortality. Old age, gross peritoneal soiling and the length of the ulcer history did not affect mortality in the absence of risk factors. No death attributable to either sepsis or abscess formation occurred when surgery was performed within 2 days of perforation. Bacterial contamination may not signify clinical peritonitis during this period. Simple closure of perforated ulcers is a more prudent choice when any risk factor is present, but definitive surgery in good-risk patients merits further evaluation.