The complex treatment of patients with perforated gastroduodenal ulcers

  • M.I. Pokydko
  • T.V. Formanchuk
  • O.V. Goncharenko
  • A.M. Formanchuk
  • V.A. Katsal
Keywords: perforated gastroduodenal ulcer, peritonitis, surgical treatment


To improve the immediate results of surgical treatment of patients with perforated gastroduodenal ulcers using minimally invasive correction and an integrated treatment. The results of 253 patients with perforated gastroduodenal ulcers who were treated from 2013 to 2018 were analyzed. Chronic ulcers were found in 82 (32%) cases among all gastric ulcers, acute ones constituted 42 (16%) cases. Chronic duodenal ulcers reached 94 (37%), acute ones constituted 35 (14%). The diagnostic laparoscopy was performed in 13 (5%) patients, in 8 (3%) patients the perforated hole was sutured laparoscopically and in 5 (2%) patients the conversion was performed. Abdominocentesis with preoperative abdominal cavity drainage was carried out in 45(18%) patients. Through this drainage after exudate evacuation 200 ml of dekasan solution was injected. In 119 cultures of abdominal exudates with determinate pathogenic microflora Enterococcus faecalis dominated - 31 patients (26%). Among the postoperative complications the failure of intestinal sutures was observed in 4 (1.5%) patients. Postoperative mortality was 11.5%. Progression of multiple organ failure became the cause of mortality in 17 (59%) patients. Thus, the time from the moment of perforation till the moment of surgery must not be the sole criterion in the choice of method of operative intervention, and it is insufficient as an absolute indicator for the possibility of the radical surgical procedures (gastric resection). Undoubtedly laparoscopic suturing of the perforated gastroduodenal ulcer has advantages over laparotomy.


1. Afendulov, S. A., Guravlev, G. U. & Krasnoluckij N. A. (2005). Lechenie probodnoy yazvu [Treatment of perforated ulcers]. Moskva.

2. Garelik, P. V., Dubrovschik, O. I., Dovnar, I. S., & Cilindz, I. T. Perforativnie gastroduodenalnie yazvu: vzglad na problemu vibora metoda operativnogo leccheniya [Perforated gastroduodenal ulcers: a look at the problem of choosing the method of surgical treatment]. Novosti hirurgii – Surgery News, 22 (3), 321–25.

3. Glanz, S. (1998). Medico-biologicheskaya statistika: per. s angl. S. Glanz. [Medico-biological statistics: Per. with English. S. Glantz]. Moskva: Praktika.

4. Gostischev, V. K., Evseev, M. A., & Golovin, R. A. (2005). Perforativnye gastroduodenalnye yazvy: vzglyad na problemu [Perforated gastroduodenal ulcers: a look at the problem]. RMJ, 13 (25), 1663–67.

5. Grinev, M. V. & Plotnikov, U. V. (2012). Sostoyanie ekstrennoy hirurgicheskoy pomoschi v Sankt-Peterburge [The state of emergency surgical care in St. Petersburg]. Vestnik hirurgii im. Grekova – Bulletin of Surgery named I.I. Grekova, 171 (3), 102-5.

6. Kozlov, A. A. (2009). Operativnoe lechenie pacientov s perforativnymi yazvami zheludka i dvenadcatiperstnoj kishki [Operative treatment of patients with perforated ulcers of the stomach and duodenum]. Aspirantskiy vestnik Povolgya – Postgraduate Bulletin of the Volga, 7-8, 87–90.

7. Sovcov, S. A. (2015). Vybor sposoba lecheniya probodnoj gastroduodenalnoj yazvy [The choice of treatment for perforated gastroduodenal ulcers]. Hirurgiya. Zhurnal im. N.I. Pirogova – Surgery. Journal named N.I. Pirogov, 11, 41–45.

8. Cukanov, Yu. T., & Nikitin, V. N. (2014). Rezultaty lecheniya pacientov s probodnoj yazvoj i rubcovoj deformaciej piloroduodenalnoj zony [The results of treatment of patients with perforated ulcer and cicatricial deformity of the pyloroduodenal zone]. Novosti hirurgii – Novosti hirurgii, 22 (3), 313–20.

9. Buck, D. L., Vester-Andersen, M., & Moller, M. H. (2013). Danish clinical register of emergency surgery. Surgical delay is a critical determinant of survival in perforated peptic ulcer. Br. .J Surg., 100 (8), 1045–1049. DOI: 10.1002/bjs.9175.

10. Szabo, S., Kusstatscher, S., Sandor, Z., & Sakoulas, G. (1995). Molecular and cellular basis of ulcer healing. Scand. J. Gastroenterol. Suppl., 208, 3–8. Retrieved from

11. Saccomani, G., Percivale, A., & Stella, M. (2003). Laparoscopic Billroth II gastrectomy for completely stricturing duodenal ulcer: technical details. Scand. J. Surg., 92 (3), 200–2. Retrieved from

12. Svanes, C. (2000). Trends in perforated peptic ulcer: incidence, etiology, treatment and prognosis. Wid. J. Surg., 24 (3), 277–83. DOI:10.1007/s002689910045.
How to Cite
Pokydko, M., Formanchuk, T., Goncharenko, O., Formanchuk, A., & Katsal, V. (2018). The complex treatment of patients with perforated gastroduodenal ulcers. Reports of Vinnytsia National Medical University, 22(3), 479-484.