A 45-year-old man presents with sudden severe epigastric pain 6 hours ago. X-ray shows free air under the diaphragm. He is hemodynamically stable with localized peritonitis. At laparotomy, a 5 mm anterior duodenal ulcer perforation is found. What is the most appropriate surgical management?

• A Truncal vagotomy and pyloroplasty
• B Billroth II subtotal gastrectomy
• C Graham patch repair (omentum patch) ✓
• D Truncal vagotomy and antrectomy

Explanation

For a perforated duodenal ulcer in a hemodynamically stable patient without shock or delayed presentation, Graham patch repair with vascularized omentum is the standard approach. Definitive acid-reducing surgery (vagotomy-based procedures) is generally avoided in the acute setting. H. pylori eradication post-operatively addresses the underlying cause in most cases.

Reference: Bailey and Love's Short Practice of Surgery, 28th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.