Year 2017 Vol. 25 No 6

GENERAL & SPECIAL SURGERY

V.N. NIKITIN 1.2, S.G. KLIPACH2

DIFFICULT STUMP IN COMPLICATED GIANT PENETRATING PYLORODUODENAL ULCERS

SBEE HPE Omsk State Medical University 1,
BME OR City Emergency Clinical Hospital 2 2, Omsk
The Russian Federation

Objective. To develop a method for treating difficult stump of the duodenum during surgery for a complicated giant penetrating pyloroduodenal ulcer.
Methods. The studied group consisted of 18 patients who underwent surgical treatment for the complicated pyloroduodenal giant ulcers. Ulcerations larger than 2.5 cm were referred to pyloroduodenal giant ulcers. One proposed the method of treating difficult duodenal stump, implying a longitudinal incision of the anterior wall of the duodenal bulb, affected by a circular ulcerative process. It allows determining the extent of ulcerative stenosis, making exterritorialy ulcer craters with the excision of the remnants of the duodenal bulb mucosa and using stenotically changed postbulbar part as a frame in the formation of the stump. Using a two-level continuous seam permits to evenly distribute the load across the seam and thus to increases the mechanical strength of the place of suturing.
Results. The average duration of the operation amounted to 136,6 minutes (95% CI:125,2; 152,0); duration of hospital treatment: from 7 to 26 days, with an average of 15.7 (95% CI:13,1; 18,2). The complications in the early postoperative period were: a wound infection 2 (11,1%), pneumonia 3 cases (16.7%), acute myocardial infarction 1 (5.5 %), failure of the stump of duodenum in one case (5.5%). Postoperative mortality amounted to 16.7%: two patients the cause was bilateral lower lobe necrotizing pneumonia (11.2%). The failure of the duodenal stump and abundant serous-fibrinous peritonitis, identified on the 6th day after the operation, occurred in one patient (5,5%). After 1 year 12 patients were examined: during endoscopy in one patient the ulcer of the posterior lip of the gastrojejunal anastomosis was revealed, superficial gastritis of the stump of the stomach was detected in 3 (25%), erosive gastritis of the stomach stump was identified in 1 (8.3%).
Conclusions. The conducted study has confirmed the efficacy of the proposed method of treating of the duodenum stump in therapy of patients with a complicated giant circular pyloroduodenal ulcer by minimizing the probability of the failure.

Keywords: pyloroduodenal ulcer, perforation, bleeding, penetration, stomach resection, the stump of the duodenum
p. 574-582 of the original issue
References
  1. Kubyshkin VA, Petrov DI, Smirnov AV. Metody endoskopicheskogo gemostaza v lechenii iazvennykh gastroduodenalnykh krovotechenii [Methods of endoscopic hemostasis in the treatment of ulcerative gastroduodenal hemorrhages]. Khirurgiia Zhurn im NI Pirogova. 2013;(9):67-72.
  2. Barkun AN, Bardou M, Kuipers EJ, Sung J, Hunt RH, Martel M, et al. International consensus recommendations on the management of patients with nonvariceal upper gastrointestinal bleeding. Ann Intern Med. 2010;152(2):101-13. doi: 10.7326/0003-4819-152-2-201001190-00009.
  3. National Institute for Health and Clinical Excellence (NICE). Acute upper gastrointestinal bleeding: management. London, UK: National Institute for Health and Clinical Excellence (NICE); 2012 Jun. 23 p. (Clinical guideline; no. 141).
  4. Kim JJ, Sheibani S, Park S, Buxbaum J, Laine L. Causes of bleeding and outcomes in patients hospitalized with upper gastrointestinal bleeding. J Clin Gastroenterol. 2014 Feb;48(2):113-18. doi: 10.1097/MCG.0b013e318297fb40.
  5. Sazhin VP, Bronshtein PG, Zaitsev OV, Kondrus IV, Krivtsov GA, Lobankov VM, i dr. Natsionalnye klinicheskie rekomendatsii Probodnaia iazva [National Clinical Recommendations Perforated Ulcer] [Elektronnyi resurs]. 37 p. Rezhim dostupa: http://obshchestvo-khirurgov.rf/upload/perforated_ulcer.pdf.
  6. Søreide K, Thorsen K, Søreide JA. Strategies to improve the outcome of emergency surgery for perforated peptic ulcer. Br J Surg. 2014 Jan;101(1):e51-64. doi: 10.1002/bjs.9368.
  7. Cienfuegos JA, Rotellar F, Valentí V, Arredondo J, Baixauli J, Pedano N, et al. Giant duodenal ulcer perforation: a case of innovative repair with an antrum gastric patch. Rev Esp Enferm Dig. 2012 Aug;104(8):436-39. [Article in Spanish]
  8. Krylov NN, Mukhammed MKh. Sushchestvuet li optimalnyi variant gastroenteroanastomoza posle distalnoi subtotalnoi rezektsii zheludka [Is there an optimal option for gastroenteroanastomosis after distal subtotal resection of the stomach?] Khirurgiia Zhurn im NI Pirogova. 2012;(8):83-86.
  9. Nikitin NA, Korshunova TP, Onuchin MA, Goloviznin AA. Khirurgicheskoe lechenie sochetannykh oslozhnenii iazvennoi bolezni pri piloroduodenalnoi lokalizatsii iazvy [Surgical treatment of combined complications of peptic ulcer with pyloroduodenal ulcer localization]. Med Alm. 2010;(1):121-25.
  10. Nobori C, Kimura K, Ohira G, Amano R, Yamazoe S, Tanaka H, et al. Giant duodenal ulcers after neurosurgery for brainstem tumors that required reoperation for gastric disconnection: a report of two cases. BMC Surg. 2016 Nov 17;16(1):75.
  11. Buck DL, Vester-Andersen M, Moller MH. Prompt Surgery Is Critical for Survival in Patients With Perforated Peptic Ulcer. Br J Surg. 2013;100:1045-49.
  12. Mukhopadhyay M, Banerjee C, Sarkar S, Roy D, Rahman1 QM. Comparative study between omentopexy and omental plugging for giant duodenal ulcer perforation. Indian J Surg. 2011 Oct; 73(5): 34145. doi: 10.1007/s12262-011-0320-8.
  13. Vavrinchuk SA, Kosenko PM, Chernyshov DS. Sovremennye aspekty khirurgicheskogo lecheniia perforativnoi iazvy dvenadtsatiperstnoi kishki: monogr [Modern aspects of surgical treatment of perforated duodenal ulcer]. Khabarovsk, RF: IPKSZ; 2013. 241 p.
  14. Tsukanov IT, Nikitin VN, Nikolaichuk AI. Sposob formirovaniia kulti dvenadtsatiperstnoi kishki pri gigantskoi tsirkuliarnoi oslozhnennoi iazve [The method of forming the stump of the duodenum with a giant circular complicated ulcer]. Patent RF 2460474. 10.09.2012.
  15. Thorsen K, Søreide JA, Kvaløy JT, Glomsaker T, Søreide K. Epidemiology of perforated peptic ulcer: Age- and gender-adjusted analysis of incidence and mortality. World J Gastroenterol. 2013 Jan 21;19(3):347-54. doi: 10.3748/wjg.v19.i3.347.
  16. Møller MH, Engebjerg MC, Adamsen S, Bendix J, Thomsen RW. The Peptic Ulcer Perforation (PULP) score: a predictor of mortality following peptic ulcer perforation. A cohort study. Acta Anaesthesiol Scand. 2012 May;56(5):655-62. doi: 10.1111/j.1399-6576.2011.02609.x.
Address for correspondence:
644043, Russian Federation,
Omsk, Lenin str., 12,
SBEE HPE Omsk State Medical University,
Department of Faculty Surgery
with the Course of Urology,
Tel: +7 3812 35-91-30,
E-mail: nikitin-1966@inbox.ru,
Vyacheslav N. Nikitin
Information about the authors:
Nikitin V.N., PhD, Associate Professor of the Department of Faculty Surgery with the Course of Urology of SBEE HPE Omsk State Medical University.
Klipach S.G., Head of Surgery Unit of BME OR City Emergency Clinical Hospital 2.
Contacts | ©Vitebsk State Medical University, 2007-2023