PERFORATED PEPTIC ULCER: FROM EARLY DIAGNOSIS TO LESS INVASIVE TREATMENT FOR A FAVORABLE PROGNOSIS

Abstract

Perforated peptic ulcer is a surgical emergency with rapid progression and a high risk of mortality. Data from DATASUS indicate that between January 2024 and April 2025, there were 1,942 deaths in Brazil related to gastric and duodenal ulcers, highlighting deficiencies in emergency care for digestive diseases. This study aimed to review the available evidence on early diagnosis and optimal therapeutic approaches. A literature search was conducted in PubMed, SciELO, Google Scholar, and MEDLINE, focusing on publications from 2020 to 2025. Review studies and original articles with full text freely available in digital format were included. Duplicate articles, publications outside the established period, and studies that did not meet the research objective or the defined methodological criteria were excluded. Of the 30 articles initially identified, 15 were selected for analysis after application of the eligibility criteria. Early diagnosis, based on patient history, physical examination, and imaging, is crucial in reducing mortality, which can exceed 50% within the first 24 hours after perforation. Minimally invasive techniques, such as laparoscopy and, in some cases, endoscopy, have shown better outcomes compared to conventional laparotomy, with lower morbidity, shorter hospitalization, and faster postoperative recovery. It is concluded that early identification of perforated ulcers and the use of less invasive techniques, when possible, are essential for reducing mortality and improving clinical outcomes. Individualized treatment, considering the severity of the case and the extent of the perforation, remains key to therapeutic success.