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In a recent article by Behrman¹ on the management of complicated peptic ulcer disease, he contends that "deviation from traditional surgical management might prove detrimental should other nonoperative modalities be used." This might be true in select cases, however, it is not applicable to the majority of peptic ulcer perforations.

Nonoperative management has yielded successful results in sealed perforated diverticulitis, sealed Boerhaave syndrome, and sealed perforated appendicitis. The same should follow for sealed perforated peptic ulcer disease.

While it was documented as early as 1843 that gastroduodenal ulcers tend to spontaneously seal,² it was not until 1935 that Wangensteen³ reported the success of nonoperative management of gastroduodenal ulcers in 9 patients. A review of cases in 1963 demonstrated that up to 80% of patients could be managed nonoperatively.⁴ Despite numerous reports of success with nonoperative management, surgical intervention became the treatment of choice for perforated peptic ulcer disease.⁵

Since that . . . [Full Text of this Article]

AUTHOR INFORMATION
Mike K. Liang, MD; Jenifer L. Marks, MD; Russell S. Berman, MD; Joseph Carter, MD

RELATED ARTICLE

Management of Complicated Peptic Ulcer Disease—Reply
Stephen W. Behrman
Arch Surg. 2005;140(9):915.
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