This Article  • Full text  • PDF  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Contact me when this article is cited  Related Content  • Related article  • Similar articles in this journal  Topic Collections  • Gastrointestinal Diseases  • Gastrointestinal/ Upper Foregut  • Alert me on articles by topic

	Since this article does not have an abstract, we have provided the first 150 words of the full text and any section headings.

In reply

Dr Liang and colleagues contend that a significant percentage of patients presenting with perforated ulcer are best managed nonoperatively if a water-soluble contrast study is normal. With the exception of the very rare nonimmunocompromised patient presenting with free air and minimal if any physical findings on examination, I would disagree.

Before embarking on a nontraditional pathway, cautious scrutiny of past experience and the surgical literature is mandatory. I offer 2 examples. Dr Liang notes that Wangensteen¹ reported the "success" of nonoperative management. However, 4 of 9 patients in his study had no free air on roentgen examination, questioning the diagnosis. Of the remaining 5 patients, 2 developed subphrenic abscess and 1 patient died of peritonitis 14 days after admission. The definition of success is clearly in the eyes of the beholder. Wangensteen himself concludes that "there can be no debate about the early (presenting) case. Closure of the . . . [Full Text of this Article]

AUTHOR INFORMATION
Stephen W. Behrman, MD

RELATED ARTICLE

Management of Complicated Peptic Ulcer Disease
Mike K. Liang, Jenifer L. Marks, Russell S. Berman, and Joseph Carter
Arch Surg. 2005;140(9):914-915.
EXTRACT | FULL TEXT