Research Information System
AHI EVRAN International Congress on Scientific Research - IV, Kırşehir, Turkey, 26 - 28 April 2024, pp.1334-1337, (Summary Text)
ABSTRACT Duodenal perforation is one of the causes of surgical acute abdomen that requires urgent surgical intervention and can be life-threatening. Although its frequency has decreased with the widespread use of proton pump inhibitors and Helicobacter pylori eradication treatment, peptic ulcer disease is still the most common cause of duodenal perforation. Apart from peptic ulcer disease, scleroderma, Crohn's disease, duodenal ischemia, chemotherapy, foreign body ingestion, trauma and tumors are other causes of duodenal perforation. Iatrogenic duodenal perforations may occur especially after endoscopic interventions (upper gastrointestinal endoscopy and endoscopic retrograde pancreaticocolongiography). Duodenal perforations most commonly occur on the front side of the first part of the duodenum. Most duodenal perforations can be successfully treated with primary repair with or without omentopexy. However, the possibility of successful treatment with primary repair decreases, especially in patients with large diameter, delayed and widespread loculated fluid and interloop abscesses in the abdomen. Tube duodenostomy is an alternative surgical method that can be widely and successfully used as a definitive or bridge treatment in patients with giant duodenal perforation, extensive fluid and abscess in the abdomen. In this case report, we aimed to present the successful treatment of a patient with giant and recurrent duodenal ulcer perforation due to peptic ulcer disease by tube duodenostomy. Case: Forty-five years old male patient. He applied to the emergency room with complaints of abdominal pain, abdominal swelling, and nausea and vomiting, which started about 10 days ago. In his medical history, he had surgery for duodenal perforation approximately 3 years ago. In physical examination; fever: 38.1°C, TA: 90/50 mmHg, pulse: 120/min. The abdomen has distention, there is widespread tenderness and rebound in the abdomen upon palpation. In laboratory findings, WBC: 17,000 mcL, CRP: 39.2 mg/dl, procalcitonin: 100 ng/ml, BUN: 62.1 mg/dl, creatine: 4.2 mg/dl. In abdominal CT, there is free air under the diaphragm and diffuse fluid containing air in all quadrants of the abdomen (Figure 1). The patient underwent emergency laparotomy under general anesthesia. A perforation area of approximately 4x3 cm in size was detected on the front side of the 1st continent of the duodenum. There was approximately 8 liters of bilious fluid and interloop abscesses in the abdomen, and the intestinal loops were severely dilated. Considering that the primary repair option would fail, tube duodenostomy underwent with the help of a 20F Pezzer catheter extending distal to the perforation area. The abdomen was cleaned by washing with approximately 10 liters of saline solution and the surgery was completed by placing 3 drains into the abdomen. On the 6th postoperative day, a leak test was performed with methylene blue from the tube duodenostomy and oral intake was allowed. The patient tolerated oral intake and a control abdominal CT was performed on the 25th postoperative day (Figure 2). No fluid or collection was observed in the abdomen. The patient, who had tube duodenostomy and abdominal drains removed at the 6th postoperative week, was discharged in full recovery. In conclusion; Tube duodenostomy is a safe surgical method that can be applied as a definitive or bridge treatment alternative to primary repair in patients with duodenal perforation, which is large in diameter, delayed and has widespread fluid collection and abscess in the abdomen.