Analysis of fifty cases of perforated peptic ulcer

This study is based on a series of fifty cases of perforated peptic ulcer treated at the Cumberland Hospital during a seven year period from 1931 to 1937. The average age of these fifty male patients was thirtynine years. There appears to be a seasonal incidence for the occurrence of this condition. The majority of cases occurred in the fall months of September, October and November. Most of these patients had a definite history of peptic ulcer symptoms for an average duration of three and onehalf years prior to perforation. The history of a sudden, sharp, severe abdominal pain followed by radiation of the pain to the shoulders appears important in the diagnosis of this condition. Objectively, the presence of marked abdominal tenderness, and rebound tenderness, with board-like rigidity of the abdominal muscles, and obliteration of liver dulness with a definite leucocytosis, make the diagnosis of the case conclusive. The most important factor in determining the outcome is the interval of time between perforation and operation. The mortality rises sharply as this length of time increases. The simplest of operative procedures, namely, aspiration of the fluid and closure of the perforation, carried out with the least additional trauma is the procedure indicated. Generalized peritonitis appears to be the cause of death in a majority of the fatal cases. It appears unlikely that this may be influenced in any way, by delaying operation to improve the patient's condition, or by changing the operative procedure. A follow-up study of 73 per cent of the cases revealed that most of the patients were entirely free of symptoms, at an average of one and one-half years following the perforation.