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Surgery
A frail elderly patient is found to have an anterior perforation of a duodenal ulcer. He has a recent history of nonsteroidal anti-inflammatory drug (NSAID) use and no previous history of peptic ulcer disease. A large amount of bilious fluid is found in the abdomen. What should be the next step?
Lavage of the peritoneal cavity alone
Lavage and omental patch closure of the ulcer
Total gastrectomy
Lavage, vagotomy, and gastroenterostomy
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