Perforated duodenal ulcer in Reading from 1950 to 1959.

During the last 15 years there has been an evolution in the management of perforated peptic ulcer. The established policy of immediate laparotomy and simple closure of the lesion has been challenged by those advocating either non-operative conservatism (Taylor and Warren, 1956) or, at the other extreme, emergency definitive surgery (Judin, 1937; Cooley, Jordan, Brockman, and DeBakey, 1955; Emmett and Williams, 1957). The purpose of this study was to assess the influence of these changing concepts of treatment upon the surgical practice in a busy district hospital. In addition, a long-term follow up was carried out with particular reference to the number of patients managed by simple closure coming eventually to definitive surgery. Subsidiary investigations were made into the natural history of those patients sustaining a second perforation. A further study into the relationship of the duration of dyspepsia before perforation and the subsequent course of the ulcer is reported elsewhere (Cassell, 1969). The records of 330 patients admitted with perforated duodenal ulcers to the Royal Berkshire Hospital, Reading, between January 1950 and December 1959 were reviewed, and all those treated operatively were followed up. Five of them sustained a second perforation during the 10 years, and therefore this report surveys the management of 335 perforations occurring in 330 patients.