Figue 26-41. Rouen gastejjanonomy.[Reprodaced vik pemission from Riche WR Jr Benign daar ofthe mack tu duoderan, icie WP, Stece C, Daan BH (eds) Goal ‘Sirgeny. Phiadetpia: Lippincot 198 p 177) a ‘Surgical options in the treatment of duoden: gastric ulcer 12 rnorcarion |oyooewat ——_|castate ‘Oxerewt | Oversew and biopsy 2Ovesew. V4D 2 Owenew. biopy-V¥>D_ BV EA 3.Dinal gusbectony® Pesfoaion 1 Pac [Biopsy and pac 2. Puch HSV 2. Welgvencivon, V+ S-Pach, VD _|3. Disa gasrecory* ‘Obsnetion ||. HSV+G! |. Biopsy, HSV + GF 2V+A 2 isl gastrectomy Tnactabiiy/|1 HSW> HSV aad wedge nonteating |2.V-+D cicison BVEA 2 Distal gestectomy Ferforation she second most commen complication of peptic ter but nowadays a more common indication fr operation than bleeding. AS with bleding ulcer, NSAID andr espirn tse have been ineiably liked with perforated PUD, espe lal ate erty population Sargey ie alot alway indi ‘cued for wkerpetfratin. although occasionally nonsurgical treatment can be used inthe stable patent witout penton jn shom rabologic studies document scaled perforation Patets with acute perforation nd GI bod loss either hoa for acute shold he suspectad of having a second ulcer oF 2 Giecancer. “The options for surgical uesement of prfottd dvodenst ‘ect are sme otc clowre, patch clea and TISV. cr patch closure apd V+ D. Simple path closure, current the most fommoaly perlormed eperstion toe perforated peptic ule should be done inpaliats mith hemodyuemie isa and! frexntativepeioniie geting a pertortion 324 boas old Instable psc withou longsueing perforation, the aion of HSV may be considered. However, nthe United Stes and ‘Wester Furope there i clewly and ancy from defnive copentin for perforated duodenal ulcer, probly becuse of te weady svalallty of PP, an surgeon untamiiaty with define operation ia this seine ®™ In te tbl pent withoumalple operative rick fac. tors, performed gastic ules ane best eae by distal gastric feacction, Vagotomy i ustlly added fr type Hand I gst ters: Pac clo ash biopsy loa excson and coax: ce biopsy, closure, tancal vagotomy, and drainage ae ake ate operations ie the Unstable ce high-k patio oF the faint with a pefortion nan inopporune location. All perio- ‘ated gastric ules oven thos inthe prepare positon, sould tebiopie i ey are mot remaved Siren. Obstructing Peptic Ulcer ‘Acute ucetsasecated with obstaction due to clei andlor ‘motor dysfunction may respond to nencve anscretory ter. ‘apy and nasogastic ection But ont patents wth ign fica