Surgical management of acute hemorrhagic postbulbar duodenal ulcer after a previous major surgical procedure

Abstract

The choice of operation for acute hemorrhagic postbulbar duodenal ulcer after an operation is discussed. Distal partial gastrectomy was performed in six patients. The ulcer was treated by resection, suture, or removal by mucoclasis. Hemostasis was attained in five patients. In another, multiple ulcers were observed in the descending portion of the duodenum and gastrectomy failed to control hemorrhage, resulting in death. Rebleeding was observed in two, one from a newly formed ulcer in the upper part of the papilla of Vater after gastrectomy with truncal vagotomy and which was halted by suture of the ulcer and another was from a newly formed ulcer in the remnant stomach after gastrectomy and which was halted by selective vagotomy and ligation of the left gastric artery. It is recommendable to perform a subtotal gastrectomy and vagotomy combined with removal of the ulcer by mucoclasis or ulcer suture. In some cases, pancreatoduodenectomy may have to be done.

Life-threatening bleeding from postbulbar duodenal ulcer saved by emergency transcatheter arterial embolization

“…1 In a recent epidemiologic survey in Japan, the incidence of this organism in apparently healthy Japanese was only 0.5%, while B. hominis was found in the feces of 5.95% of asymptomatic individuals in Australia. 1,2 The pathogenic role of B. hominis has not yet been established.…”

“…1 In a recent epidemiologic survey in Japan, the incidence of this organism in apparently healthy Japanese was only 0.5%, while B. hominis was found in the feces of 5.95% of asymptomatic individuals in Australia. 1,2 The pathogenic role of B. hominis has not yet been established. Pathogenesis has been reported, however, in immunosuppressed patients, for example, patients with acquired immunodeficiency syndrome, children receiving chemotherapy, renal transplant recipients, and chronic renal failure patients, as in this case.…”

“…The association of B. hominis with human disease is still controversial. 1 However, diarrhea and abdominal pain are reported symptoms of B. hominis infection.…”

Surgical treatment ofduodenal postbulbarulcer complicated withmechanical jaundice

“…Средний возраст больных с залуковичными язвами выше, чем больных с типичной дуоденальной язвой [13]. Постбульбарные язвы резистентны к консервативной терапии [41], часто осложняются тяжелыми кровотечениями, склонными к рецидивированию [12,22,42].…”

“…Разработаны методики вирсунгопапиллопластики [1,5], реимплантации БДС в двенадцатиперстную кишку [11], сегментарные резекции двенадцатиперстной кишки с реимплантацией желчного и панкреатического протоков [25,32]. В качестве альтернативного вмешательства при осложненных околососочковых язвах можно рассматривать панкреатодуоденальную резекцию, об успешном выполнении которой в этой ситуации имеется несколько сообщений [24,28,42].…”