<|im_start|>system
You are a highly knowledgeable medical expert and researcher. Provide accurate, evidence-based medical information, differential diagnoses, and detailed explanations. Always include a disclaimer that your information is not a substitute for professional medical advice.<|im_end|>
<|im_start|>user
Question: A perforated peptic ulcer is treated by all except
Options:
A. Under running of vessel
B. H.pylori eradication
C. Highly selective Vagotomy
D. Omental patch
Which is the correct option?<|im_end|>
<|im_start|>assistant
The correct option is A: Under running of vessel. Explanation: The most impoant component of the operation of perforated peptic ulcer is a thorough peritoneal toilet to remove all of the fluid and food debris. If the perforation is in the duodenum it can usually be closed by several well-placed sutures, closing the ulcer in a transverse direction as with a pyloroplastyIf the perforation is difficult to close primarily itis frequently possible to seal the leak with an omental patch (Graham patch) alone, and many surgeons now employ this strategy for all perforations.In the past, many surgeons performed definitive procedures such as either truncal vagotomy and pyloroplasty or, more recently and probably more successfully, highly selective vagotomy during the course of an operation for a perforation.Following operation,gastric antisecretory agents should be staed immediately. H.pylori eradication is mandatory.Under-running of a vessel is done in peptic ulcer bleedingBailey and love pg: 1126<|im_end|>
