Surgical treatment of patients with ulcerative gastroduodenal bleeding: clinical cases

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详细

The article presents two clinical cases of treatment of treating patients with ulcerative gastroduodenal bleeding from large chronic ulcers. In one case, the source of bleeding was a giant callous chronic gastric ulcer. The patient urgently underwent subtotal gastric resection with an inter-intestinal anastomosis according to the Roux procedure (18 hours after admission to the hospital), taking into account the high risk of recurrence of bleeding. In the second case, a patient with bleeding from a large chronic duodenal ulcer was operated on urgently (24 hours after admission to the hospital) in the following volumes: laparotomy, stitching of a duodenal ulcer, pyloroplasty according to Finney, subdiaphragmatic stem vagotomy. The purpose of the following clinical observation data is to demonstrate therapeutic tactics in relation to a group of patients with ulcerative gastroduodenal bleeding from large (more than 2.0 cm) chronic ulcers, high comorbidity and high risk of recurrence of bleeding.

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作者简介

Vladimir Verbitsky

Kirov Military Medical Academy; I.I. Dzhanelidze Saint Petersburg Research Institute of Emergency Medicine

Email: verbitsky1961@mail.ru
ORCID iD: 0000-0001-6969-7270
SPIN 代码: 6981-0621

MD, Dr. Sci. (Medicine), Professor

俄罗斯联邦, Saint Petersburg; Saint Petersburg

Anton Parfenov

Kirov Military Medical Academy; Saint Petersburg I.I. Dzhanelidze Research Institute of Emergency Medicine

编辑信件的主要联系方式.
Email: parfenov_anton@mail.ru
ORCID iD: 0009-0009-8238-678X
SPIN 代码: 1620-6415

MD, Cand. Sci. (Medicine), Associate Professor

俄罗斯联邦, Saint Petersburg; Saint Petersburg

Andrey Demko

Kirov Military Medical Academy; I.I. Dzhanelidze Saint Petersburg Research Institute of Emergency Medicine

Email: demkoandrey@gmail.com
ORCID iD: 0000-0002-5606-288X
SPIN 代码: 3399-8762

MD, Dr. Sci. (Medicine), Professor

俄罗斯联邦, Saint Petersburg; Saint Petersburg

Ivan Yastrebov

I.I. Dzhanelidze Saint Petersburg Research Institute of Emergency Medicine

Email: ipyastreb@gmail.com
ORCID iD: 0000-0003-4139-415X
俄罗斯联邦, Saint Petersburg

Alexey Kosachev

Kirov Military Medical Academy; I.I. Dzhanelidze Saint Petersburg Research Institute of Emergency Medicine

Email: avkos1@mail.ru
ORCID iD: 0009-0005-2073-6159
SPIN 代码: 6137-4356
俄罗斯联邦, Saint Petersburg; Saint Petersburg

Egor Yurkevich

Kirov Military Medical Academy

Email: yurkeviche1997@mail.ru
ORCID iD: 0009-0006-2090-149X
SPIN 代码: 1245-4409
俄罗斯联邦, Saint Petersburg

参考

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  2. Paimela H, Paimela L, Myllykangas-Luosujarvi R, Kivilaakso E. Current features of peptic ulcer disease in Finland: incidence of surgery, hospital admissions and mortality for the disease during the past twenty-five years. Scan J Gastroenterol. 2002;37(4):399–403. doi: 10.1080/003655202317316015
  3. Sarosi GA, Jaiswal KR, Nwariaku FE, et al. Surgical therapy of peptic ulcers in the 21st century: more common than you think. Am J Surg. 2005;190(5):775–779. doi: 10.1016/j.amjsurg.2005.07.019
  4. Ng EK, Lam YH, Sung JY, et al. Eradication of Heliobacter pylori prevents recurrence of ulcer after simple closure of duodenal ulcer perforation. Ann Surg. 2000;231(2):153–158. doi: 10.1097/00000658-200002000-00001
  5. Laursen SB, Hansen JM, Andersen PE, Schaffalitzky de Muckadell OB. Supplementary arteriel embolization an option in high-risk ulcer bleeding – a randomized study. Scand J Gastroenterol. 2014;49(1):75–83. doi: 10.3109/00365521.2013.854829
  6. Lau JYW, Pittayanon R, Wong KT, et al. Prophylactic angiographic embolisation after endoscopic control of bleeding to high-risk peptic ulcers: a randomised controlled trial. Gut. 2018;68(5):796–803. doi: 10.1136/gutjnl-2018-316074
  7. Mille M, Huber J, Wlasak R, et al. Prophylactic transcatheter arterial embolization after successful endoscopic hemostasis in the management of bleeding duodenal ulcer. J Clin Gastroenterol. 2015;49(9):738–745. doi: 10.1097/MCG.0000000000000259
  8. Perehodov SN, Karpun NA, Sniczar’ AV, et al. Endovascular embolization for prevention of recurrent bleeding from the upper gastrointestinal tract. Pirogov Russian Journal of Surgery. 2023;(1):30–38. EDN: HFBJIU doi: 10.17116/hirurgia202301130
  9. Lolle I, Møller MH, Rosenstock SJ. Association between ulcer site and outcome in complicated peptic ulcer disease: a Danish nationwide cohort study. Scand J Gastroenterol. 2016;51:1165–1171. doi: 10.1080/00365521.2016.1190398
  10. Schroder VT, Pappas TN, Vaslef SN, et al. Vagotomy/drainage is superior to local oversew in patients who require emergency surgery for bleeding peptic ulcers. Ann Surg. 2014;259(6):1111–1118. doi: 10.1097/SLA.0000000000000386
  11. Sinenchenko GI, Verbitsky VG, Gmir SV. The choice of therapeutic approach to severe ulcerative gastroduodenal bleeding among patients with high surgery risk. Bulletin of the Russian military medical academy. 2009;2(26):11–15. EDN: KTNQPL

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2. Figure. Type of surgical wound. A site of an ulcer defect on the posterior-upper wall of the duodenal bulb (intraoperative photo)

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