In a highly selected subset of patients, a perforated peptic ulcer may be managed without surgery when specific criteria are met. This protocol defines that scenario and the structured non-operative approach that applies.
The perforation has sealed, confirmed on water-soluble contrast study with no contrast extravasation. The patient shows no signs of peritonitis or sepsis and presents with stable, normal vital signs. Non-operative management is considered only in this carefully selected group — it is not appropriate for routine use in perforated peptic ulcer.
Where criteria are met, management is non-operative and inpatient. It centres on bowel rest and a combination of supportive interventions — among them measures targeting acid secretion. The complete structured regimen, including all components and monitoring requirements, is available in the full protocol.
In patients with perforated peptic ulcer we suggest against a routinely use of non-operative management; non-operative management (NOM) could be considered in extremely selected cases where perforation has sealed as confirmed on water-soluble contrast study (weak recommendation based on low-quality evidences, 2C).
On the other hand, NOM could be considered if no contrast extravasation is present and the patient does not have signs of peritonitis or sepsis.
NOM includes: nil by mouth; intravenous hydration; decompression via nasogastric tube; anti-secretory and PPI therapy; intravenous antibiotics; and follow-up endoscopy at 4–6 weeks.
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