Ten-Year Experience of Managing Giant Duodenal Ulcer Perforations with Triple Tube Ostomy at Tertiary Hospital of North India

Abstract

Duodenal ulcer perforations have been known since 1600 AD. It is a common surgical emergency and every surgeon will encounter it. The perforation size of >2 cm has been used as the criteria for defining Giant duodenal ulcers. The management of giant duodenal perforations in hemodynamically unstable patient with comorbid condition is taxing because of high incidence of the postoperative leak and mortality. We have used the simple technique of Triple Tube Ostomy after the primary closure of the defect with encouraging results. It is a retrospective study done at the J. N medical college AMU Aligarh from May 2005 to May 2015. Hemodynamically unstable patients who have presented to the emergency with preoperative diagnoses of giant duodenal ulcer perforation and had undergone triple tube ostomy with primary repair of the perforation were included in the study. There were 34 patients of giant duodenal perforation who presented in shock. All of them underwent triple-tube-ostomy after primary repair of the duodenum. Thirty-two patients recovered with two mortalities (5.8 %). Several definite surgical techniques have been described for the management of giant duodenal ulcer perforation but they are complex, have very high morbidity and mortality rate and require an expert surgeon. A close retrospective scrutiny of the patients suggests that simple triple-tube-ostomy technique which is based on the principle of damage control surgery has good postoperative results Therefore, we recommend it as the procedure of choice in these patients.