The authors compared the outcome in 40 high-risk patients who had a perforated benign gastric ulcer with respect to management by omental patch closure (OPC) or partial gastrectomy (PG). The patients were considered to be at high risk because of the presence of one or more of the following factors: age more than 70 years; initial hypotension; delay from presentation to operation of more than 12 hours; and significant premorbid illness. OPC was performed in 22 patients and PG in 10; the other 8 patients were initially managed nonoperatively (NonOp). Death rates were 40% overall--36% for patients in the OPC group, 30% for those in the PG group and 63% for those in the NonOp group. The hospital stay was more than 12 days for 57% of the OPC group, 86% of the PG group and 67% of the NonOp group. Sixty-eight percent of patients in the OPC group, 90% in the PG group and 89% in the NonOp group had complications. There was no significant difference in death rates between those treated with OPC and PG. There was a trend to lower death rates in patients over 70 years of age who underwent PG (1 of 6) compared with those who underwent OPC (7 of 12). The authors concluded that partial gastrectomy, a definitive surgical treatment for gastric ulcer disease, is not contraindicated in high-risk patients who have a perforated benign gastric ulcer.