The surgical management of benign gastroduodenal perforation

Gastric perforations may be spontaneous or traumatic and most of the spontaneous perforation is due to peptic ulcer disease. Improved medical management of peptic ulceration has reduced the incidence of perforation, but still remains a common cause of peritonitis. The management of perforated peptic ulcer disease is still a subject of debate. The majority of perforated peptic ulcers are caused by Helicobacter pylori, so apart from simple closure, definitive surgery is not usually required. Perforated peptic ulcer is an indication for operation in nearly all cases except when the patient is unfit for surgery. However, with the current advances in anaesthetic approach and with the high incidence of intra-abdominal abscesses and sepsis, non-operative management has largely been abandoned.