Traitement de l'ulcère gastro-duodénal perforé.

Seventy-four patients, admitted in emergency for acute perforation of a duodenal or gastric ulcer were reviewed retrospectively: 40 patients with one or several risk factor such as shock, old perforation, severe chronic illness or advanced age and 34 other patients without any risk factor. In this selected population, the surgical treatment, initially performed in 44 cases, consisted of suturing the perforation and draining the peritoneal cavity in all cases but four in which it was associated with a vagotomy (2 cases) or a distal gastrectomy (2 cases). Thirty younger patients admitted without shock, within 6 hours following the onset of the perforation were initially treated by digestive aspiration alone: this medical treatment was successful in 15 patients but required a subsequent laparotomy in the other cases. The overall postoperative mortality is 18% but is zero in the group of patients in whom a medical therapy was initially performed. Long-term follow-up shows that 70% of the patients with a perforated duodenal ulcer and without any anti-inflammatory drug past history at the time of the perforation are free from any symptom. A strategy for the management of perforated duodenal and gastric ulcers, applicable to a non-selected population, is proposed in reference to the surgical literature.