Treatment of perforated peptic ulcer includes -a) i.v. fluidsb) Drainage of paracolic gutterc) Immediate surgeryd) Antacidse) i.v. pantoprazole

Management of Peptic ulcer perforation Nasogastric tube: whenever a perforated ulcer is suspected, the first step is to pass a nasogastric tube and empty the stomach to reduce further contamination of the peritoneal cavity. Intravenous crystalloid: The patient is resuscitated aggressively by administration of intravenous crystalloid. Intravenous broad-spectrum antibiotics Surgery: Surgery is mostly indicated, although occasionally nonsurgical treatment can be used in stable patients without peritonitis, and in whom radiologic studies document a sealed perforation. Surgery whether laparoscopy or laparotomy involves two components: i) Thorough peritoneal toilet to remove all the fluid and food debris  drain is not indicated ii) Management of perforation For duodenal ulcer perforation The most frequently performed operation for a perforated duodenal ulcer is simple closure with an omental onlay reinforcement or patch. This is combined with postoperative H. pylori eradication (antibiotics + antisecretory agents) Insertion of a nasoenteric or jejunal feeding tube should be considered For gastric ulcer perforation All perforated gastric ulcers are best treated by distal gastric resection with or without a truncal vagotomy (Truncal vagotomy can be added for type II & III gastric ulcers. Type I and IV gastric ulcers do not need acid reducing procedures as they are associated with hyposecretion). Ulcer is removed along with gastric resection as it carries a risk of malignancy (cf: duodenal ulcer has no risk of cancer). If ulcer is left behind, biopsy is always done. - Other procedures used for gastric ulcers are -     patch closure with biopsy - wedge excision and closure Conservative Management: Conservative management may be tried in stable patients without peritonitis, and in whom radiologic studies document a sealed perforation. In conservative management, the patient is observed closely and treated with nasogastric suction, IV fluids intravenous acid secretion suppression, and intravenous broad-spectrum antibiotics.