Growth rate of tumours

Abstract

I concur with your leading article concerning perforated duodenal ulcer (Br J Surg 1987; 74: 81-2). The implication that unnecessary definitive surgery in the acute state of management should be avoided must be correct; but why not take the argument one step further?The overall mortality rate today for patients with perforated peptic ulcer treated surgically is approximately'4 5 per cent. This is of the same order as that reported for conservative management in 1956'.A recent prospective randomized trial of non-operative uersus operative treatment for perforated duodenal ulcer6 has demonstrated the possibility of treating certain groups of patients by non-operative means.Such a treatment regimen would allow the subsequent definitive surgery to be undertaken on a properly selected group of patientsat time of relapse during medical therapy. Using this regimen as many as 75 per cent6 of all patients suffering perforation of a duodenal ulcer may completely escape the need for surgical intervention. T. J. CroftsUniuersity of Aberdeen Aberdeen AB9 2 2 0 U K I. 2.3. 4. 5.6. GrecoPS, Cahow CE. Alternatives in the management of acute perforated duodenal ulcer. Am J Surg 1974; 127: 109-14. b e y J, Wong J, Ong BG. A prospective study of operative risk factors in perforated duodenal ulcers. Ann Surg 1982; 195: 265-9. Sawyers JL, Herrington JL Jr, Mulherin JL Jr, Whitehead WA, Mody R. Acute perforated duodenal ulcer. Arch Surg 1975; 110: Coutsoptides T, Himal HS. Perforated gastroduodenal ulcers. ,4m J Surg 1976; 132: 575-30. Seeley SF, Campbell D. Nonoperative treatment of perforated