Alcoholic episode in etiopathogenesis of perforated ulcers
Nikitin V.N.^1,2, Poluektov V.L.¹, Zablotskaya E.A.³, Klipach S.G.<sup>2

1</sup> Omsk State Medical University
² City Clinical Emergency Hospital No. 2, Omsk
³ Clinical Medical Unit No.9, Omsk

According to the world statistics the perforated ulcer takes the leading place in the structure of the mortality of duodenal bulb ulcer complications.
The aim of the study was to determine the role of the alcoholic episode in the etiopathogenesis of the perforated duodenal ulcer. 
Patients and Methods: The authors studied twelve patients operated for duodenal bulb ulcer during the period from April 2014 to May 2017. Among them there were 10 men (83.3%), 2 women (16.7%), the average age was 39.33 years. Inclusion criteria: the patient had a perforated duodenal ulcer and an alcoholic episode in the anamnesis. The amount of ethanol in the venous blood was determined by the standard method of gas chromatography. Surgical intervention included upper and midline laparotomy, excision of the ulcer with a perforated aperture (with subsequent histological examination) and duodenoplasty with the use of a double-layer continuous suture with the application of node "locks", sanitation and drainage of the abdominal cavity.
Results: In 91.7% of cases, the concentration of ethanol in the blood of patients on admission corresponds to mild and moderate alcohol intoxication. In 100% of the patients the morphological study showed: inflammatory-dystrophic changes in the wall of the vascular bed in the ulcerative lesions area, inflammatory endoneural edema and degeneration of intermuscular neural plexuses, and the presence of thrombosed intramural vessels in the perforation area. The results allowed to consider the pathogenesis of the perforated ulcer from the position of the hypothesis of acute microthrombosis, triggered by alcohol. The average duration of the operation was 79.6 min; the average duration of inpatient treatment was 10.8 bed-days. Postoperative complications and deaths were not observed.
Conclusion: Alcohol episode, regardless of the amount of consumption, triggers a cascade of pathological reactions, the outcome of which is an acute microthrombosis of altered vessels of the intestinal wall, acute ischemia and necrosis of the affected segment with the formation of end-to-end defect in the bottom of the ulcer crater. The use of the proposed method of radical duodenoplasty is reproducible.

Key words: perforated duodenal ulcer, alcoholic episode, acute microthrombosis theory, duodenoplastic.
For citation: Nikitin, V.N. Poluektov V.L., Zablotskaya E.A., Klipach S.G. Alcoholic episode in etiopathogenesis of perforated ulcers // RMJ. 2017. № 28. P. 2048–2052.