Combined conservative management and percutaneous peritoneal drainage as damage control approach in high-risk patients with perforated peptic ulcers

High risk patients with perforated peptic ulcer, where both the surgeon and anaesthetist are hesitant to operate, were managed by combined conservative management bilateral percutaneous peritoneal drainage under local anaesthesia as a damage control approach; followed either definitive surgery or omental patch closure. Here we study outcome in terms of morbidity & mortality such patients. A prospective 60 presenting VSSIMSAR, Burla was done between Feb 2018 Jan 2020. Study population includes ulcer confirmed pneumo-peritoneum X-ray bilious tap; high peri-operative (PULP score 8-18). They anaesthesia. The improved general condition definitive/ closure, rates noted. After stratification according PULP score, total number high-riskcases >8) (male-39, female-21); Majority them elderly (90%). Most common complication ARDS (28.3%). Maximum (75%) approach without significant complications offered exploratory laparotomy needful. Localised abscess observed around 13.33% patients; which image guided aspiration antibiotic coverage. overall rate 11.67%. Combined control, can be resource limited centre; closure is associated reduced mortality.