A 55-year-old man undergoes emergency laparotomy for perforated peptic ulcer. A 1 cm perforation is found at the anterior wall of the first part of the duodenum. H. pylori testing is positive. The most appropriate surgical treatment at this emergency is:

• A Truncal vagotomy and pyloroplasty
• B Omental (Graham) patch repair of the perforation ✓
• C Billroth II gastrectomy
• D Laparoscopic highly selective vagotomy

Explanation

For perforated duodenal ulcer, emergency omental patch repair (Graham patch) is the procedure of choice — the perforation is closed with interrupted sutures and reinforced with a tongue of omentum sutured over it. This is a minimal, rapid operation appropriate for an acutely ill patient. Definitive ulcer surgery (vagotomy, gastrectomy) is no longer performed at the time of emergency repair because H. pylori eradication and proton pump inhibitors reduce recurrence risk dramatically. Post-operatively, H. pylori eradication is confirmed and treated.

Reference: Bailey & Love's Short Practice of Surgery, 27th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.