Marginal Ulcer Perforation in a Whipple Survivor: A Rare Long-Term Complication

Abstract

Long-term complications following pancreaticoduodenectomy are rarely reported because of the poor longterm survival of these patients. Marginal ulcers can occur in both the short and long term, and they can become complicated by bleeding or perforation. Marginal ulcer with perforation is a rare incidence and only sparse literature evidence is available. Herein, we report on a patient who underwent pancreaticoduodenectomy 12 years ago for duodenal adenocarcinoma and was diagnosed to have perforation peritonitis. He underwent emergency laparotomy and lavage, and omental patch closure for marginal ulcer perforation at the gastrojejunostomy site. Truncal vagotomy and feeding jejunostomy were also done.

Perforated marginal ulcer following Whipple procedure: A case report

“…6 The incidence of marginal ulcer ranges from 0% to 18% , and the median time to diagnosis is 15.5 months. 3 In our case , patient presented with the condition after 6 years of surgery.…”

“…1,2,6 Risk factors include smoking, use of alcohol, Non-steroidal anti-inflammatory drugs (NSAIDS), immunosuppressive medications and discontinuation of Proton pump inhibitors (PPI) among others. 3,8 Treatment of marginal ulcer consists of elimination of risk factors, PPI , and regular endoscopic monitoring. 9 They are rarely refractory to medical management which brings up the necessity of revision surgery that includes resection and reconstruction of anastomosis.…”

Perforated marginal ulcer following Whipple procedure: A case report

“…5,6 While several mechanisms have been proposed for the etiology of these ulcers, the commonly believed mechanisms include gastric acid, inflammation, angulation, foreign bodies, and ischemia on the gastrojejunal anastomosis. 1,2,6 Risk factors include smoking, use of alcohol, Nonsteroidal anti-inflammatory drugs (NSAIDS), immunosuppressive medications, and discontinuation of PPI, Helicobacter pylori infection among others., 3,5,8 Our patient probably had poor compliance to prescribed PPI.…”

“…Marginal ulcer, one of the rare long‐term complications of pancreatoduodenectomy, is ulceration that occurs at or around the gastrointestinal anastomosis 2 . Their associated morbidity and mortality have been infrequently described in literature 3 . Here we present a case of a gentleman with a 6‐year‐old history of Whipple procedure who presented in emergency department with acute onset abdominal pain and was later diagnosed with perforated marginal ulcer.…”

“…2 Their associated morbidity and mortality have been infrequently described in literature. 3 Here we present a case of a gentleman with a 6-year-old history of Whipple procedure who presented in emergency department with acute onset abdominal pain and was later diagnosed with perforated marginal ulcer.…”