Perforation of the giant duodenenal ulcers in elderly and senile patients
Nikitin V.N.1, Poluektov V.L.1, Klipach S.G.2, Sitnikova V.M.1
1 Omsk State Sedical University
2 City Clinical Hospital of Emergency Medical Care №2, Omsk
Aim: to develop and introduce into clinical practice the method of radical duodenoplasty in operations for a giant circular perforated ulcer of the duodenal bulb.
Patients and Methods: Between April 2016 and January 2017, three men were operated in the surgical department of the Omsk City Clinical Hospital of Emergency Medical Care №2 for a giant circular perforated ulcer of the duodenal bulb. The age of the patients was 69, 76, 81 years, mean age — 75.3 years (95% CI 60.4–90.3). Ulcerative history: 11, 25 and more than 40 years, an average of 25.3 years (95% CI 10.7–61.4), patients were repeatedly treated for the active duodenal ulcer. All patients were operated on within 6 hours from the moment of perforation. Inclusion criteria: the patient has a giant circular perforated ulcer of the duodenal bulb, elderly age, informed consent of the patient to be included in the study. Surgical intervention was performed in the volume of upper-midline laparotomy, excision and exteriorization of the ulcer craters, omentoplasty, formation of duodenal end-to-end anastomosis with a continuous two-layer suture, lavage and drainage of the abdominal cavity.
Results: The mean duration of the operation was 108.3 minutes (95% CI: 64.7, 151.9). The length of hospital stay varied from 13 to 18 bed-days, on average — 14.7 (95% CI: 7.5, 21.8). Complication occurred in the early postoperative period: wound infection — 33.3%, right focal pneumonia — 33.3%. Complications that caused the death of the patients were not observed.
Conclusion. The use of the proposed method of radical duodenoplasty with continuous two-layer suture of a giant circular perforated ulcer of the duodenum bulb makes it possible to minimize the probability of insufficiency of the sutures and intestinal bleeding in the early postoperative period. The method is reproducible and can be recommended for the use in clinical practice.
Key words: perforated giant duodenal ulcer, penetration, bleeding, radical duodenoplasty.
For citation: Nikitin V.N., Poluektov V.L., Klipach S.G., Sitnikova V.M. Perforation of the giant duodenenal ulcers in elderly and senile patients // RMJ. Medical Review. 2018. № 2(II). P. 55–59.
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