A 30-year-old man presents with an acute perforated duodenal ulcer. Omental patch repair (Graham patch) is performed. Postoperatively, what is the most important investigation before discharge?

• A Helicobacter pylori testing and eradication if positive ✓
• B Upper GI endoscopy to exclude malignancy
• C Gastric acid secretion study (pentagastrin stimulation)
• D Repeat CT abdomen to verify no residual leak

Explanation

H. pylori eradication is mandatory after perforated duodenal ulcer repair, as H. pylori is the underlying cause in approximately 70% of cases and failure to eradicate leads to high recurrence rates (>80% at 10 years vs <5% after eradication). Testing (UBT, stool antigen, or biopsy) and eradication therapy (triple or quadruple regimen) significantly reduce ulcer recurrence and the need for long-term acid suppression. Upper GI endoscopy is more important for gastric ulcers to exclude malignancy, not required routinely for duodenal ulcers.

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

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