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Treatment of PU perforation, Drainage procedures - Coggle Diagram
Treatment of PU perforation
Resuscitation
NPO, IVF, Foley catheter, NGT, Abx, Analgesics and antipyretics
Surgery (open midline laparotomy)
Drain the pus and food and perform peritoneal toilet
Take a biopsy (in case of gastric perforation)
If benign, treat the perforation and follow up
If malignant, treat as gastric cancer
Emergency closure (all acute cases)
Graham patch procedure (omental flap)
On 5-7 postoperation day start:
Mtronidazole
Esomeprazole
H. pylori treatment (for 1-2 months)
Oral fluids
CT abdomen with gastrographin may be considered before starting oral fluids
Definitive surgery (after 6 months if the patient is noncompliant, neglected, or no easy access to health care)
Truncal vagotomy with drainage procedure (recurrence is 5-7%)
Selective vagotomy with drainage procedure (recurrence is 10%)
Highly selective vagotomy (no drainage is required) (recurrence is 20-25%)
Drainage procedures
Pyloroplasty
Heineke-Mikulicz pyloroplasty
Finney pyloroplasty
Jaboulay pyloroplasty
Gastrojejunostomy