Final answer:
The management of a ruptured peptic ulcer with fresh gastric contents in the peritoneal cavity and an old perforation involves emergency surgery and intensive antibiotic therapy.
Step-by-step explanation:
When fresh gastric contents are found in the peritoneal cavity and the perforation appears several hours old, it indicates a ruptured peptic ulcer. In such cases, the management typically involves emergency surgery to repair the perforation and intensive antibiotic therapy to prevent infection.
The mortality rate from peritonitis associated with ruptured peptic ulcers used to be high, but advancements in surgery, anesthesia safety, critical care expertise, and antibiotics have significantly improved the outcome. However, the mortality rate still ranges from 30 to 40 percent in such cases.