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    CHAPTER 46  SURGERY FOR PEPTIc ULcER DIsEAsE 607 • Copious irrigation of the abdominal cavity • Definitive ulcer operation—a patient who has had a perforation for less than 22 hours and is hemodynamically stable without significant comorbidities should undergo a definitive ulcer operation if he or she has known PUD, has been receiving medical therapy for PUD, or is taking medication that increases the risk of PUD. The major distinction between surgical management of perforated duodenal and perforated gastric ulcers is that in all cases of perforated gastric ulcers, carcinoma must be excluded.

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