Alternative approach of complicated peptic ulcer perforation in recurrent and delayed—two cases

Abstract Gastric and duodenal ulcer perforation represents one of the most critical causes of acute abdomen, necessitating urgent surgical intervention. While primary repair with omental patch remains the standard treatment for uncomplicated cases, alternative surgical approaches may be preferable in complex or delayed presentations. We illustrate this variability through two distinct cases. Case I: A recurrent gastric perforation managed via wedge resection using linear staplers, reinforced with Lembert sutures to ensure staple-line integrity. Case II: A delayed duodenal perforation treated with Heineke-Mikulicz duodenoplasty combined with omentoplasty to address tissue edema and mitigate leakage risk. These cases highlight the necessity of adapting surgical strategies to patient-specific factors, such as perforation chronicity, tissue viability, and prior intervention history. Unlike routine repairs, complex scenarios often demand advanced techniques to optimize outcomes and reduce morbidity.