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Research Article | DOI: https://doi.org/BRCA-RW-25-30

Outcomes of Non-Operative Management of Perforated Peptic Ulcer Disease: A Comprehensive Review

Moses Adondua Abah 1*, Onyinye Ifeoma Ikedionwu 2, Obagade Ibukunoluwa Oluwatoy 2, Praise Udoka Oputa 2, Jemiseye Abayomi Victor 2, Ezeudu Paschal Chikelum 2

1Department of Biochemistry, Faculty of Biosciences, Federal University Wukari, Taraba State, Nigeria

2Department of Medicine and Surgery, College of Medicine, University of Lagos, Idi-Araba, Lagos state, Nigeria

*Corresponding Author: Moses Adondua Abah,Department of Biochemistry, Faculty of Biosciences, Federal University Wukari, Taraba State, Nigeria

Citation: Moses Adondua Abah , Onyinye Ifeoma Ikedionwu, Obagade Ibukunoluwa Oluwatoy, Praise Udoka Oputa, Jemiseye Abayomi Victor et al (2025). Outcomes of Non-Operative Management of Perforated Peptic Ulcer Disease: A Comprehensive Review, J Biomedical Research and Clinical Advancements; 2(4) 30, DOI: BRCA-RW-25-30

Copyright: Moses Adondua Abah, et al © (2025). This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Received: 05 August 2025 | Accepted: 16 August 2025 | Published: 28 August 2025

Keywords: perforated peptic ulcer; surgery, non-operative management; disease; patients; diagnosis

Abstract

Perforated peptic ulcer disease (PPUD) represents a serious complication of peptic ulcer disease and is traditionally managed surgically. However, with evolving clinical practices and improved supportive care, non-operative management (NOM) has emerged as a viable alternative for select patient populations. This comprehensive review examines current evidence on the outcomes of NOM in the treatment of PPUD, focusing on patient selection criteria, clinical success rates, complications, and overall prognosis. The review synthesizes data from observational studies, clinical trials, and case reports to evaluate the safety and efficacy of conservative treatment strategies, which typically include intravenous antibiotics, proton pump inhibitors, nasogastric decompression, and close clinical monitoring. Patients considered for NOM are generally hemodynamically stable, without signs of generalized peritonitis or sepsis, and often have localized perforations confirmed by imaging. Findings indicate that NOM can be successful in up to 40–80% of appropriately selected cases, with reduced morbidity, shorter hospital stays, and lower healthcare costs compared to operative interventions. Imaging modalities such as CT scans are instrumental in guiding diagnosis and monitoring progress. The risk of failure, however, remains significant in patients with delayed presentation, large perforations, or underlying malignancies. Mortality rates in failed NOM cases tend to be higher, emphasizing the importance of stringent selection and vigilant follow-up. This review highlights the importance of individualized care pathways, the role of multidisciplinary teams, and the potential for NOM to become a standard option in carefully chosen patients. It also underscores the need for randomized controlled trials to establish definitive treatment guidelines and improve prognostic tools for patient stratification. In conclusion, while surgery remains the cornerstone for managing PPUD, NOM offers a promising alternative for a subset of patients. When applied under the right conditions, it can lead to favorable outcomes without the risks associated with surgical intervention. Nevertheless, cautious patient selection, rigorous monitoring, and prompt conversion to surgery when indicated are critical to the success of this approach.

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