A patient with a perforated duodenal ulcer presents 6 hours after onset with peritonitis. At laparotomy, the perforation is 5 mm and the surrounding tissue is healthy. After peritoneal lavage and debridement, the most appropriate repair technique is:

• A Graham patch omentoplasty ✓
• B Primary closure alone
• C Truncal vagotomy and pyloroplasty
• D Distal gastrectomy (Billroth I)

Explanation

Graham patch omentoplasty (using a tongue of viable omentum to reinforce the primary closure or fill the perforation without formal suture closure) is the gold-standard repair for perforated duodenal ulcer in the current era of PPI therapy and H. pylori eradication. Primary suture closure alone without omentoplasty has a higher leak rate for larger perforations. Definitive acid-reducing operations (vagotomy) are no longer routinely performed given effective medical therapy. Gastrectomy is reserved for failed repair or haemorrhage.

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.