The case series of peritonitis due to perforated peptic ulcer: How does conservative management play role?

INTRODUCTION: Surgical intervention is a conventional treatment for perforated peptic ulcer patients. This study aims to determine whether and how conservative non-operative management plays role in patients with pneumoperitoneum-peritonitis due to perforated peptic ulcers. METHODS: A 9-year retrospective study was conducted in patients, who visit one surgeon service, with peritonitis due to perforated peptic ulcer and received non-operation conservative treatment. The treatment consists of nasogastric suction, intravenous fluid (IV) resuscitation, IV antibiotic and IV omeprazole. Outcomes and clinical course of conservative treatment in the selected group were reviewed. Factors associated with those outcomes and clinical course were analyzed. RESULTS: There were 38 patients in this case series. Of which, 36 patients (94.7%) showed improvement after 24 h of conservative treatment and discharged without operation. Two patients underwent laparotomy in the 3(rd) day of admission due to severe abdominal pain and progression of abdominal sign. There was no mortality in this case series. The conservative series had shorter hospital stay and lesser complication but prolong fever. Three factors indicated good outcomes in this series were found i.e. 1) free air in abdominal x-ray was not broader than the 1(st) lumbar vertebral column height, 2) no free fluid seen in intra-peritoneal cavity by bedside ultrasound, 3) resuscitate fluid in the first 24 h was not more than 5 ml/kg/h. CONCLUSION: In this case series, conservative non-surgical management showed good results for patients with peptic ulcers perforation. It could be used as an effective alternative modality when carefully patient selection and closely observed.