Perforated peptic ulcer in the Vancouver area: a survey of 852 cases.

A total of 852 perforations of peptic ulcers occurring in the Greater Vancouver area during the decade 1959-1968 have been studied. The incidence of perforation has declined during this period owing to a decrease in the number of perforations occurring in males. The incidence of perforation was similar to that in the South of England and New Zealand (approximately 10 per 100,000 population) but less than half that reported from Scotland.The sex ratio of 3.6 males to 1 female was similar to that found in other countries. The mean age of the males was 53.9 years and of the females 56.5 years. The peak incidence occurred in the decade 40 to 49 years. Patients with gastric perforations were significantly older than patients with pyloroduodenal perforations.Perforation occurred most frequently in the late afternoon, on Wednesday and during December; least commonly during the night, at the beginning of the week and through September.The pyloroduodenal was the commonest site of perforation (88%) and the usual treatment was simple closure (81%). The overall mortality rate was 18.3% and one-third of all fatalities were due to misdiagnosis. The operative mortality rate was 9%.