Giant duodenal ulcers

Newton, Eric; Versland, Mark; Sepe, Thomas

doi:10.3748/wjg.14.4995

Cited by 12 publications

(11 citation statements)

References 29 publications

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“…Giant DU perforation, however remains a challenge to the general surgeon and is considered as a distinct surgical entity [11,13]. The presence of extensive duodenal tissue loss associated with surrounding inflammation and fibrosis results in high failure rates with the use of the standard omental patch repair [24].…”

Section: Conclusion -Discussion and Review Of Literaturementioning

confidence: 99%

“…Post-operative leak is one of the most feared complications and leak rates remain high up to 13% with significant morbidity and mortality [12]. Many of the techniques above also do not address the other major complication seen in this group of patients which is gastric outlet obstruction [13].…”

Section: Conclusion -Discussion and Review Of Literaturementioning

confidence: 99%

“…Giant DU perforations are defined as > 2cm [11]. They are associated with high leak rates and mortality [12,13]. Prognosis in elderly patients are particularly poor because of advanced age and comorbidities [14,15].…”

Section: Introductionmentioning

confidence: 99%

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Duodenojejunostomy, an Old Technique but Novel Solution for Giant Duodenal Perforations - A Report of Four Cases and Review of Literature

Lee¹,

Shulin²,

Li³

et al. 2020

SCR

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Background: Despite advances in the medical management of peptic ulcer disease, duodenal ulcer (DU) perforation remains a common surgical emergency. Most DU perforations are small and can be managed with omental patch repair. However, occasionally the surgeon may encounter a giant perforation not amenable to this. Giant DU perforations are defined as > 2cm. They are associated with high leak rates and mortality. Prognosis in elderly patients are particularly poor because of advanced age and comorbidities. Furthermore, there are no specific recommendations for their management despite a variety of repair techniques being described. Here, we aim to describe a novel technique used to treat such patients, especially those of advanced age, in our institution and to review the current literature. Case presentation: Four patients with giant DU perforation underwent emergency laparotomy and repair with our duodenojejunostomy technique at our hospital. Post-operatively, patients were monitored clinically and radiologically and discharged when well and tolerating diet. The mean age of the patients was 67 years with an equal gender distribution. The average Charlson Comorbidity Index (CCI) score was 3 (moderately severe). All presented with peritonitis and two had concomitant bleeding. There were two anterior and two posterior ulcers. One was a revision repair after a leak post laparoscopic omental patch repair for the initial perforation. In all cases, the duodenojejunostomy repair technique was used. Post-operative recovery was uneventful for all except one who developed pneumonia. In particular; there were no anastomotic leaks, intra-abdominal collections, gastric outlet obstructions or mortalities. Conclusion: Giant DU perforation remains a challenge to the general surgeon, particularly so in elderly patients with multiple comorbids. A review of the current literature suggests a myriad of surgical techniques but no perfect solution. Some suggested techniques include omental patch with pyloric exclusion, controlled tube duodenostomy, jejunal pedicled graft or serosal patch, gastric disconnection and partial gastrectomy. Here, we propose that isolated duodenojejunostomy can be a quick, safe and novel solution that ensures definitive repair of giant ulcer perforation in a single setting in the high-risk patient.

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Section: Conclusion -Discussion and Review Of Literaturementioning

confidence: 99%

Section: Conclusion -Discussion and Review Of Literaturementioning

confidence: 99%

See 1 more Smart Citation

Duodenojejunostomy, an Old Technique but Novel Solution for Giant Duodenal Perforations - A Report of Four Cases and Review of Literature

Lee¹,

Shulin²,

Li³

et al. 2020

SCR

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“…The history of GDU dates back to 1931, when Brdiczka first described these exceptionally large ulcers. [ 11 ] A GPU is an emergency for the gastroenterologist, especially in children, because of their higher rates of perforation, massive hemorrhage, severe anemia, and other serious complications. [ 12 ]…”

Section: Discussionmentioning

confidence: 99%

The characteristics of 83 giant peptic ulcers in Chinese children: Evaluation and follow-up

Tang

Shi

et al. 2018

Saudi J Gastroenterol

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Background/Aims:Giant peptic ulcers (GPUs) are detrimental for all patients, especially for children. However, few reports have described GPUs in children. This study aims to evaluate the characteristics of GPUs in Chinese children and to identify risk factors.Patients and Methods:We retrospectively analyzed patients at the Children's Hospital of Fudan University from April 2014 to August 2017. Patients with GPUs (>2.0 cm) were included in the study, and the clinical data, pathological characteristics and presence of Helicobacter pylori (H. pylori) infection were analyzed to evaluate the outcomes.Results:A total of 19208 children underwent gastroscopic examinations, and 83 patients with GPUs were enrolled. The mean age of onset for GPU patients was 9.7 ± 3.2 years(range, 1-15). The main complaints were abdominal pain (92.7%), anemia (53%), retching (45.8%), hematochezia (21.7%) and hematemesis (16.9%). With respect to the types of GPU, 68 patients (81.9%) had duodenal ulcers, and 15 patients (18.1%) had gastric ulcers. Compared to the group <6 years of age, the group ≥6 years was more susceptible to GPU (P < 0.05). Among GPU patients, 71.1% of cases were H. pylori (+) (59/83), and 16.9% (14/83) of patients were H. pylori (-). Compared to the H. pylori (-) group, the H. pylori (+) group showed inflammatory activity, atrophy and lymphoid follicular formation in the gastric mucosa (P < 0.05).Conclusions:This study suggests that GPUs are strongly associated with H. pylori infection in Chinese children. Duodenal ulcers are the main type of GPU in patients older than 6 years. Appropriate diagnosis, treatment and follow-up are necessary for children with GPUs.

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“…Up to now, data accounting for differences in pathophysiology that lead a certain patient to develop these giant duodenal ulcer variants have been scanty [21]. Different explanations involve genetic predisposition, dietary or environmental factors, microbial influence, variations in immunological response, or any combination of these factors [22,23], besides H. pylori infection and NSAID use.…”

Section: Discussionmentioning

confidence: 99%

Giant Prepyloric Ulcer Haemorrhage: Patient Characteristics, Treatment, and Outcome in 2003–2012

Peetsalu

Kirsimägi

Peetsalu

2014

Ulcers

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The aim of the study was to characterize patients with giant prepyloric ulcer haemorrhage, their treatment, and outcome. The data for 929 peptic ulcer haemorrhage (PUH) patients were divided into three groups according to ulcer location: group I: 165 prepyloric ulcer patients, group II: 353 gastric ulcer patients, and group III: 411 duodenal ulcer patients. Among these groups giant ulcer (ulcer diameter ≥ 2 cm) haemorrhage cases were selected for the study and the data for group I were compared with the data for groups II and III. The study shows that the proportion of giant ulcers in all prepyloric ulcers was significantly 2.2 times lower compared with the proportion of giant ulcers in all gastric ulcers and 1.5 times lower than the proportion of giant ulcers in all duodenal ulcers. The share of surgical therapy for haemorrhages from giant prepyloric ulcers did not differ from the share of surgical therapy in the case of giant gastric ulcers but was 3.5 times lower than in the case of giant duodenal ulcers. Generally, treatment for PUH from giant prepyloric ulcers was successful not involving inhospital mortality.

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Giant duodenal ulcers

Cited by 12 publications

References 29 publications

Duodenojejunostomy, an Old Technique but Novel Solution for Giant Duodenal Perforations - A Report of Four Cases and Review of Literature

Duodenojejunostomy, an Old Technique but Novel Solution for Giant Duodenal Perforations - A Report of Four Cases and Review of Literature

The characteristics of 83 giant peptic ulcers in Chinese children: Evaluation and follow-up

Giant Prepyloric Ulcer Haemorrhage: Patient Characteristics, Treatment, and Outcome in 2003–2012

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