Reliable procedure for closing the duodenal stump for bleeding posterior duodenal ulcer

Abstract

Bleeding posterior duodenal ulcers is a critical problem especially in patients of advanced age. Surgical treatment should obtain efficient and stable hemostasis and avoid digestive fistulas due to leakage of the duodenal stump. The main difficulty lies in the closure of the duodenal stump. A procedure using intramural dissection of the duodenum and closure by means of a stapler is reported for a series of 40 patients without recurrent bleeding or duodenal fistula. Seven patients (17%) died from associated diseases, especially respiratory insufficiency (3 patients) and cirrhotic liver failure (2 patients).

Technique of Antroduodenectomy Without Ulcer Excision as a Safe Alternative Treatment for Bleeding Chronic Duodenal Ulcers

“…Classically, the duodenal stump is closed with sutures or staples, but the danger of lacerating inflammatory tissue is well recognized, and the mean risk of fistula can reach 5% [5,10]. To enable duodenal closure using healthy tissue, the ''wheeling-off'' of the duodenum to an area of safety, has been proposed [14]. However, because of local inflammatory modifications, it can be difficult to achieve this procedure, and there are major risks of injury to the bile duct, the pancreas, or the pancreaticoduodenal artery.…”