Novel factors associated with surgical conversion for duodenal perforation: case control study

Background: Based on initial evaluation using indication criteria, conservative treatment or surgery is selected for duodenal ulcer perforation. However, some patients fail conservative management and require surgical intervention. This study aimed to identify novel predictive factors during initial assessment that signal the need for conversion to surgery. Methods: This retrospective cohort study analyzed 27 patients who underwent initial conservative management for duodenal ulcer perforation at a single institution between January 2012 and July 2023. The surgical conversion rate was evaluated. Assessed variables included patient demographics, time from symptom onset to hospital admission, vital signs, inflammatory markers (e.g., C-reactive protein and white blood cell count), and computed tomography (CT) scan findings (perforation site, degree/shape of liver coverage over the perforation, and ascites volume). Results: Of the 27 patients, 17 successfully completed conservative treatment (conservative group), while 10 required surgery (surgical conversion group). No significant differences were observed between groups in demographics, time to admission, body temperature, inflammatory markers, or ascites volume. However, the degree and anatomical configuration of liver coverage over the perforation site differed significantly between groups ( P < 0.05). Conclusion: The anatomical relationship be the data that support the findings of this study are available from the corresponding author upon reasonable request. Tween the liver and perforation site, particularly the degree and morphology of liver coverage observed on initial CT imaging, may serve as a novel predictor for surgical conversion in patients initially managed conservatively for duodenal ulcer perforation. This finding highlights the potential role of spatial liver anatomy in guiding clinical decision-making.