Year 2017 Vol. 25 No 6




SBEE HPE Omsk State Medical University 1,
BME OR City Emergency Clinical Hospital 2 2, Omsk
The Russian Federation

Objective. To develop a method for treating difficult stump of the duodenum during surgery for a complicated giant penetrating pyloroduodenal ulcer.
Methods. The studied group consisted of 18 patients who underwent surgical treatment for the complicated pyloroduodenal giant ulcers. Ulcerations larger than 2.5 cm were referred to pyloroduodenal giant ulcers. One proposed the method of treating difficult duodenal stump, implying a longitudinal incision of the anterior wall of the duodenal bulb, affected by a circular ulcerative process. It allows determining the extent of ulcerative stenosis, making exterritorialy ulcer craters with the excision of the remnants of the duodenal bulb mucosa and using stenotically changed postbulbar part as a frame in the formation of the stump. Using a two-level continuous seam permits to evenly distribute the load across the seam and thus to increases the mechanical strength of the place of suturing.
Results. The average duration of the operation amounted to 136,6 minutes (95% CI:125,2; 152,0); duration of hospital treatment: from 7 to 26 days, with an average of 15.7 (95% CI:13,1; 18,2). The complications in the early postoperative period were: a wound infection 2 (11,1%), pneumonia 3 cases (16.7%), acute myocardial infarction 1 (5.5 %), failure of the stump of duodenum in one case (5.5%). Postoperative mortality amounted to 16.7%: two patients the cause was bilateral lower lobe necrotizing pneumonia (11.2%). The failure of the duodenal stump and abundant serous-fibrinous peritonitis, identified on the 6th day after the operation, occurred in one patient (5,5%). After 1 year 12 patients were examined: during endoscopy in one patient the ulcer of the posterior lip of the gastrojejunal anastomosis was revealed, superficial gastritis of the stump of the stomach was detected in 3 (25%), erosive gastritis of the stomach stump was identified in 1 (8.3%).
Conclusions. The conducted study has confirmed the efficacy of the proposed method of treating of the duodenum stump in therapy of patients with a complicated giant circular pyloroduodenal ulcer by minimizing the probability of the failure.

Keywords: pyloroduodenal ulcer, perforation, bleeding, penetration, stomach resection, the stump of the duodenum
p. 574-582 of the original issue
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Address for correspondence:
644043, Russian Federation,
Omsk, Lenin str., 12,
SBEE HPE Omsk State Medical University,
Department of Faculty Surgery
with the Course of Urology,
Tel: +7 3812 35-91-30,
Vyacheslav N. Nikitin
Information about the authors:
Nikitin V.N., PhD, Associate Professor of the Department of Faculty Surgery with the Course of Urology of SBEE HPE Omsk State Medical University.
Klipach S.G., Head of Surgery Unit of BME OR City Emergency Clinical Hospital 2.
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