Abstract
Background
Peptic ulcer perforation is a common surgical emergency and a major cause of death especially in elderly patients, despite the fact of the presence of effective drug treatments and an increased understanding of its etiology. Giant duodenal perforations, in particular, pose a significant challenge and there is scarce data regarding their optimal management. Laparoscopic surgery is advocated in the surgical treatment of perforated duodenal ulcer disease, in experienced hands.
Methods
Herein we present an 84-year-old man with past medical history of type II diabetes mellitus and hypertension who was admitted to our Department due to epigastric pain and diffuse peritonitis. CT scan revealed the presence of a significant amount of free air and fluid in the upper abdomen secondary to a duodenal perforation.
Results
The patient was taken immediately to the theater for an urgent laparoscopy. Methylene blue via the NG tube better defined the extent of the duodenal perforation which was not amenable to a primary repair. Consequently, a decision was made for a laparoscopic pancreas-sparing, ampulla preserving gastroduodenectomy with intracorporeal Billroth II gastrojejunal anastomosis. The postoperative period was uneventful and the patient was discharged on the 13th postoperative day. Histopathology revealed a large benign duodenal ulcer.
Conclusions
Although the incidence of peptic ulcer disease is decreasing, it appears that the incidence of complications is rising. Laparoscopic approach, especially when performed by laparoscopic surgery experts, could be a treatment option for difficult duodenal ulcer perforations with less pain, shorter hospital stay and reduced morbidity.
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References
Bertleff MJ, Lange JF (2010) Perforated peptic ulcer disease: a review of history and treatment. Dig Surg 27:161–169
Møller MH, Shah K, Bendix J, Jensen AG, Zimmermann-Nielsen E, Adamsen S et al (2009) Risk factors in patients surgically treated for peptic ulcer perforation. Scand J Gastroenterol 44:145–152
Rickard J (2016) Surgery for peptic ulcer disease in Sub-Saharan Africa: systematic review of published data. J Gastrointest Surg 20(4):840–850
Crofts TJ, Park KGM, Steel RJC et al (1989) A randomized trial of nonoperative treatment for perforated peptic ulcer. N Engl J Med 320:970–973
Cocks JR (1992) Perforated peptic ulcer: the changing scene. Dig Dis 10:10–16
Lanas A, Serrano P, Bajador E et al (1997) Evidence of aspirin use in both upper and lower gastrointestinal perforation. Gastroenterology 112:683–689
Bertleff MJ, Halm JA, Bemelman WA, van der Ham AC, van der Harst E, Oei HI et al (2009) Randomized clinical trial of laparoscopic versus open repair of the perforated peptic ulcer: the LAMA Trial. World J Surg 33:1368–1373
Clinch D, Damaskos D, Di Marzo F, Di Saverio S (2021) Duodenal ulcer perforation: a systematic literature review and narrative description of surgical techniques used to treat large duodenal defects. J Trauma Acute Care Surg 91(4):748–758
Di Saverio S, Franchi C, Kremel D, Lark ME, Todero S, Damaskos D (2021) Technique for pancreas-sparing total duodenectomy and reconstruction of a neoduodenum using a free interposed jejunal limb with ampullojejunostomy and Roux-en-Y anastomosis. Case reports. Br J Surg 108(2):e71–e73
Di Saverio S, Segalini E, Birindelli A, Todero S, Podda M, Rizzuto A, Tugnoli G, Biondi A (2018) Pancreas-sparing, ampulla-preserving duodenectomy for major duodenal (D1–D2) perforations. Br J Surg 105(11):1487–1492
Schein M (2005) Perforated peptic ulcer. In: Schein's common sense emergency abdominal surgery, Part III. Springer, Berlin, pp 143–150
Agaba EA, Klair T, Ikedilo O, Vemulapalli P (2016) A 10-year review of surgical management of complicated peptic ulcer disease from a single center: is laparoscopic approach the future? Surg Laparosc Endosc Percutan Tech 26(5):385–390
Quan Y, Huang A, Ye M et al (2016) Comparison of laparoscopic versus open gastrectomy for advanced gastric cancer: an updated meta-analysis. Gastric Cancer 19(3):939–950
Tan S, Wu G, Zhuang Q, Xi Q, Meng Q, Jiang Y, Han Y, Yu C, Yu Z, Li N (2016) Laparoscopic versus open repair for perforated peptic ulcer: a meta analysis of randomized controlled trials. Int J Surg 33(Pt A):124–132
Quah GS, Eslick GD, Cox MR (2019) Laparoscopic repair for perforated peptic ulcer disease has better outcomes than open repair. J Gastrointest Surg 23(3):618–625
Cirocchi R, Soreide K, Di Saverio S, Rossi E, Arezzo A, Zago M, Abraha I, Vettoretto N, Chiarugi M (2018) Meta-analysis of perioperative outcomes of acute laparoscopic versus open repair of perforated gastroduodenal ulcers. J Trauma Acute Care Surg 85(2):417–425
Paterson-Brown S (1993) Emergency laparoscopic surgery. Br J Surg 80:279–283
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Drs. Dimitrios Oikonomou, Elisa Bottazzoli, Dimitrios Damaskos and Salomone Di Saverio have no conflicts of interest or financial ties to disclose.
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Oikonomou, D., Bottazzoli, E., Damaskos, D. et al. Laparoscopic distal gastric and D1 resection for large perforated duodenal bulb peptic ulcer, with intracorporeal antecolic gastrojejunal anastomosis. Surg Endosc 36, 6997–6999 (2022). https://doi.org/10.1007/s00464-021-08955-4
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DOI: https://doi.org/10.1007/s00464-021-08955-4