Plication of Perforated Peptic Ulcer
Perforated duodenal ulcer. ESSENTIAL STEPS 1. Upper midline incision. 2. Culture and aspirate any peritoneal fluid. 3. Explore the abdomen with special attention to the stomach and duodenum and identify perforation. 4. Place interrupted sutures across margins of perforation. 5. Bring healthy omentum over the defect and secure in place by tying previously placed sutures. 6. Lavage the peritoneal cavity with large volumes of normal saline. 7. Check position of the nasogastric tube. 8. Check hemostasis. 9. Close the abdomen.