Gastric lavage in patients with acute poisoning is an important component of the complex of detoxification activities at the pre-hospital stage of medical care. Non-compliance with the rules of gastric lavage may result in iatrogenic complications, among which 4.9% are gastric injuries by the probe. The analysis of treatment of 8,926 patients poisoned with non-cauterizing substances was performed. In 44 of them (0.5%), there were signs of gastroduodenal bleeding, caused by trauma of the gastric mucosa and in 12 patients (0.13%), there was perforation of a gastric wall by a probe. The main method of endoscopic hemostasis in patients with bleeding was infiltration hemostasis with epinephrine solution, with the exception of 5 patients with bleeding of type F1a and F2a, where the combined hemostasis with argon-plasma coagulation was performed. All 12 patients with gastric perforation were urgently operated. Prevention of gastric trauma during lavage at the prehospital stage is the strict implementation of the procedure developed by the staff of the Center for Treatment of Acute Poisoning at the

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The article is devoted to the problem of emergency surgery for abdominal organs – perforated ulcer of the posterior duodenal wall (duodenum). 140 patients with perforated duodenal ulcer were treated at the N.V. Sklifosovsky Research Institute for Emergency Medicine between 2016 and 2019. Eight patients had perforation from the penetrating ulcer of the posterior duodenal wall. The average age of patients with perforation from the penetrating ulcers in the posterior duodenal wall was 62.25 years (27 to 78 years). Most of the cases were found in men – 87.5%. 7 patients had surgery at the Institute, one was transferred from another medical institution where he underwent surgery. Four patients were discharged with a favorable outcome, and four died. Two of the deceased patients had perforation associated with penetrating duodenal ulcer that was diagnosed during laparotomy; in two other cases, perforation associated with the penetrating ulcer was detected only during autopsy. A feature of perforated gastroduodenal ulcers when they are localized on the posterior wall of the duodenum is poor clinical manifestation, which is associated with the entry of duodenal contents into a limited retroperitoneal space, leading to a significant inflammatory process of retroperitoneal tissue. Complex use of X-ray examination, oesophagogastroduodenoscopy, and CT allows to correctly assess and timely diagnose perforation associated with the penetrating ulcer of the posterior wall of the duodenum into the retroperitoneal space.

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