Non-Operative Management of Perforated Peptic Ulcer Disease: Outcomes and Evidence Review

Perforated Peptic Ulcer Disease (PPUD) is a serious complication traditionally managed surgically. With advances in supportive care, non-operative management (NOM) has emerged as a promising alternative for select patients. This review synthesizes evidence from observational studies, clinical trials, and case reports to evaluate the outcomes, safety, and limitations of NOM in PPUD. Conservative treatment typically involves intravenous antibiotics, proton pump inhibitors, nasogastric decompression, and close clinical monitoring. The NOM is generally suitable for hemodynamically stable patients without generalized peritonitis or sepsis and with localized perforations confirmed by imaging. Reported success rates range from 40-80%, with reduced morbidity, shorter hospitalization, and lower healthcare costs compared to surgery. Imaging, particularly CT scans, is crucial for diagnosis and monitoring. However, risk of failure increases with delayed presentation, large perforations, or malignancy, and mortality is higher when surgery is delayed after failed NOM. These findings underscore the importance of cautious patient selection, multidisciplinary care, and timely surgical conversion when indicated. While surgery remains essential in complicated cases, NOM offers a safe alternative for selected patients. Future randomized controlled trials are needed to establish standardized protocols and improve prognostic tools for patient stratification.