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

Abstract

Background: High risk patients with perforated peptic ulcer, where both the surgeon and anaesthetist are hesitant to operate, were managed by combined conservative management and bilateral percutaneous peritoneal drainage under local anaesthesia as a damage control approach; followed by either definitive surgery or omental patch closure. Here we study the management outcome in terms of morbidity & mortality of such patients.
Materials and Methods: A prospective study of 60 patients presenting to VSSIMSAR, Burla was done between Feb 2018 and Jan 2020. Study population includes patients with perforated peptic ulcer confirmed by pneumo-peritoneum in X-ray and bilious peritoneal tap; with high peri-operative risk (PULP score 8-18). They were managed by combined conservative management and bilateral percutaneous peritoneal drainage under local anaesthesia. The outcome in terms of improved general condition and definitive/ omental patch closure, morbidity and mortality rates were noted.