The conservative management consisted of IV fluids, intravenous
antibiotics (Cefotoxime and Metronidazole) and IV Omeprezole.
Ryle’s tube no 18 was used to empty the stomach by constant
suction. An accurate tube placement in the distal greater curvature
is crucial. A strict input-output chart, a two hourly pulse rate, the
blood pressure(BP) and the temperature were recorded. The
abdomen was examined frequently for distension, tenderness and
bowel sounds. For the first 2-3 days, absolutely nothing was given
by mouth. For the first 4-5 days, the senior surgeon examined the
cases 2-3 times daily. The conservative treatment was discontinued
if the patient failed to improve or if he/she deteriorated (increasing
pulse rate, pyrexia, abdominal distension or pain) after 12 hours
of the treatment. Clear fluids were started on the 4th to 5th day,
with the nasogastric tube being blocked. The patients were
carefully watched for signs of peritonitis. If they tolerated well, the
nasogastric tube was removed and liquid feeds were started.
A majority of the patients were discharged 10-15 days later, with
anti-ulcer and anti-H. pylori treatment. An upper GIT endoscopy
after 1 month was advised.