Controlled tube duodenostomy in the management of giant duodenal ulcer perforation—a new technique for a surgically challenging condition

Lal, Pawanindra; Vindal, Anubhav; Hadke, Niladhar S.

doi:10.1016/j.amjsurg.2008.09.028

Cited by 40 publications

(28 citation statements)

References 13 publications

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“…Nevertheless each of these procedures have shown a high incidence of duodenal dehiscence (> 10%) and a high mortality (10-65%) (3,4,(7)(8)(9)(10).…”

Section: Discussionmentioning

confidence: 99%

“…The use of an isolated jejunal loop as serosal patch is the preferred technique, concurrently others have adduced duodenal diversion claiming the technical complexity in the severe peritonitis scenario as well (7,8,10).…”

Section: Discussionmentioning

confidence: 99%

“…Perforation of GDUs is particularly hazardous and represent a surgical challenge regarding the closure of the severe duodenal wall defect and surrounding inflammation (6)(7)(8)(9).…”

Section: Discussionmentioning

confidence: 99%

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Giant duodenal ulcer perforation: a case of innovative repair with an antrum gastric patch

Cienfuegos

Rotellar

Valentí³

et al. 2012

Rev. esp. enferm. dig.

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Backgrounds: the treatment of a perforated giant duodenal ulcer (GUDs) represents a formidable surgical challenge regarding the duodenal wall defect repair in severe peritonitis setting. A high incidence of dehiscence and hospital mortality (15-40%-has been reported with the majority of the techniques).We report a case of GUDs perforation successfully treated with a subtotal gastrectomy and a gastric patch with the remnant antrum, for repairing the duodenal defect.Case report: a 63-years-old man with antecedents of peptic ulcer disease presents a large duodenal ulcer perforation with 48 hrs delay and associated with severe peritonitis and a retroperitoneal collection. A subtotal gastrectomy with Billroth II reconstruction and reconstruction of the duodenal defect with a patch of the remnant antrum was carried out. The patient was discharged at 17 th postoperative day with good tolerance.Discussion: the duodenal defect repair with a patch of the remant antrum, represents a valid alternative in similar circumstances. To our knowledge, it appears to be the first clinical description of this technique Key words: Giant ulcer. Perforation. Gastric patch. Duodenal repair. INTRODUCTIONDespite the efficacy of medical treatment of peptic ulcer disease (PU), an already increase incidence of severe PU complications -bleeding, perforation-have been reported, attributed to the indiscriminate use of non-steroidal antiinflammatory and low-dose aspirin (1-3).These complications usually occur in patients suffering of concurrent medical illness and are associated with an increased operative mortality (15-40%). Patient age older than 70 years, a delay in the surgical treatment, preoperative shock (Blood pressure < 100 mmHg), hypoalbuminemia, metabolic acidosis and renal dysfunction have identified as poor prognostic factors (2-4).The giant duodenal ulcer (GUDs) perforation (a fullthickness peptic ulcer 2 cm or larger in diameter and usually involving a large portion of the duodenum) is a rare entity that represents a formidable surgical challenge regarding the duodenal defect repair specially when is associated with life-threatening peritonitis.We describe the case of perforated GDUs, associated with systemic inflammatory response, successfully treated with a partial gastrectomy and a patch with the remnant antrum for closing the large duodenal defect. To our knowledge, it represents the first clinical report with this technique. CASE REPORTA 63-years-old man was referred from a local hospital because persisting abdominal pain, with nausea, vomiting and weakness. Five days earlier, the patient consulted in the referring hospital because of sudden abdominal epigastric pain irradiated to right hypocondrium, associated with nausea and vomiting undigested food particles. An upper endoscopy revealed a double pylorus sign, with one of the REV ESP ENFERM DIG (Madrid) Vol. 104. N.° 8, pp. 436-439, 2012 Received: 10-02-2012 Accepted: 02-03-2012Correspondence: Javier A.-Cienfuegos. Department of General and Digestive Surgery. Clínica Univ...

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“…Nevertheless each of these procedures have shown a high incidence of duodenal dehiscence (> 10%) and a high mortality (10-65%) (3,4,(7)(8)(9)(10).…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Giant duodenal ulcer perforation: a case of innovative repair with an antrum gastric patch

Cienfuegos

Rotellar

Valentí³

et al. 2012

Rev. esp. enferm. dig.

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“…Review of the medical literature does not reveal any reports of LFP in the emergency setting. This procedure, with an open approach, is in fact undertaken in cases of benign GOO, and is only rarely performed in the emergency setting since it is more technically challenging than the Heineke-Mikulicz pyloroplasty (20)(21)(22)(23). FP can be used particularly when the site of the perforation is too wide and located in D2, to ensure good caliber of the pylorus when no healthy tissue around the ulcer can provide good closure of the duodenal defect (18,24).…”

Section: Discussionmentioning

confidence: 99%

Laparoscopic Finney pyloroplasty in the emergency setting: first case report in the literature and technical challenges

Moggia

Athanasopoulos

Hadjittofi

et al. 2016

Annals of Translational Medicine

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Pyloroplasty is currently reserved for emergencies (perforation, bleeding), but may occasionally be performed to treat benign gastric outlet obstruction (GOO). Historically, two techniques are available: the Mikulicz pyloroplasty, by which the pylorus is incised longitudinally and sutured vertically, and the Finney pyloroplasty, by which a U-shaped inverted incision is made in the second part of duodenum (D1-D2), followed by a side-toside gastroduodenostomy. We report our experience in this single case of laparoscopic Finney pyloroplasty (LFP) performed in the emergency setting for a woman with a perforated duodenal ulcer and severe loss of tissue in D1-D2. Due to the presence of severely inflamed perforation edges and the risk of duodenal narrowing with subsequent GOO, Finney technique was favored over direct ulcer repair. The patient achieved a full postoperative recovery free of complications, with a dynamic oral contrast study demonstrating good gastric evacuation. Review of the current literature revealed no similar cases, as LFP has only been performed in the canine model. Although LFP requires a specific surgical skill-set, we believe it can be effective and feasible in cases of duodenal perforation with significant loss of mural substance.

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“…This is more comfortable for the patient than a long-term nasogastric tube and also reduces the risk of aspiration and respiratory complications. 11 A jejunostomy was placed, avoiding the need for long-term parenteral nutrition and its associated risks. 12 It is our assumption that the patient's duodenal ulcer had perforated after admission for his pneumonia.…”

Section: Discussionmentioning

confidence: 99%

Triple-ostomy: management of perforations to the second part of the duodenum in patients unfit for definitive surgery

Herrod

Kamali

Pillai

2011

annals

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Peptic ulcers in the second part of the duodenum are a rare occurrence and present challenging management. Conventional surgical operations are associated with life threatening complications. We describe a case of a perforated duodenal ulcer in a medically unstable patient who was deemed unfit for lengthy definitive surgery. An emergency laparotomy and 'triple-ostomy' was performed. We recommend this procedure as an alternative for the emergency repair of D2 ulcers, especially in patients with multiple co-morbidities. case HistoryA 57-year-old man was admitted with right sided chest pain and increasing shortness of breath. He was commenced on treatment for right middle lobe pneumonia. Twenty-four hours into admission he deteriorated and suffered increasing abdominal pain and so a surgical opinion was sought.The patient had been discharged three weeks prior to this admission following a stroke. During that previous admission he had developed pneumonia and was therefore discharged on antibiotics. Past medical history included bronchiectasis and osteoarthritis, for which he was taking diclofenac. On examination, the patient looked cachetic and unwell and had cool clammy peripheries. His pulse was 90 beats/min and regular, his blood pressure 90/50mmHg, respiratory rate 25 breaths/min, oxygen saturation 93% on 35% O 2 and he had a temperature of 37.5 o C. There was generalised abdominal tenderness with guarding and rebound. A digital rectal examination was normal.A full blood count showed a white cell count of 26.7 x 10 9

show abstract

Controlled tube duodenostomy in the management of giant duodenal ulcer perforation—a new technique for a surgically challenging condition

Cited by 40 publications

References 13 publications

Giant duodenal ulcer perforation: a case of innovative repair with an antrum gastric patch

Giant duodenal ulcer perforation: a case of innovative repair with an antrum gastric patch

Laparoscopic Finney pyloroplasty in the emergency setting: first case report in the literature and technical challenges

Triple-ostomy: management of perforations to the second part of the duodenum in patients unfit for definitive surgery

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