Peritonitis secondary to a blocked perforated ulcer: management

We report the case of a 42 years old young patient who was examined in the emergency department for epigastric pain lasting for 3 days. The abdominal tomodensitometry allowed to highlight the presence of an intra peritoneal effusion without pneumopertoneum. The patient underwent an exploratory laparoscopy. There was peritoneal toilet

Bile Leak following Laparoscopic Cholecystectomy due to Perforated Duodenal Ulcer in Patient with Roux-en-Y Gastric Bypass

Perforated ulcers of the excluded stomach or duodenum are exceedingly rare in patients who have undergone Roux-en-Y gastric bypass surgery. The diagnosis of perforated ulcer after Roux-en-Y gastric bypass remains challenging as there is often absence of free air or contrast extravasation from the biliopancreatic limb. We present a patient with signs and symptoms of acute cholecystitis. Laparoscopic cholecystectomy was complicated by postoperative bile leak. EDGE procedure was performed to access the remnant stomach and endoscopic evaluation revealed a perforated ulcer in the posterior duodenal bulb. Although unusual, in patients with bariatric surgery and upper abdominal pain, differential diagnosis including perforated ulcer of the biliopancreatic limb must be considered and early surgical exploration is essential.

The Emergency Hospital Bucharest to the Forefront of the Emergency Laparoscopic Surgery Development

The use of laparoscopy in traumatic and non-traumatic abdominal surgical emergencies is unanimously accepted due to the well-known advantages of minimally invasive surgery. In the period 1961-1966 in the Clinical Emergency Hospital of Bucharest (CEHB) the first diagnostic laparoscopes were performed in the acute surgical abdomen, respectively in the obstructive jaundice by dr. Gh.Popovici, respectively dr.C.Petrescu.In the modern era, the first laparoscopic cholecystectomy was performed in 4 dec. 1993 by A.E.N.In 1994 the first laparoscopic appendectomies, gynecological emergencies, exploration in traumatic abdominal contusion, followed by perforated ulcer (1995), intestinal occlusion (1997), were performed. In the specialized literature, out of the 42 emergency laparoscopy articles published in the journal “Chirurgia” (1994-2019), 16 (38,08%) belonged to the CEHB team, 11 of AEN. In 2004 the original monograph "Laparoscopic Emergency Surgery" appeared. Specialized chapters are added in different volumes of surgical pathology. At the Romanian Assocation of Endoscopic Surgery Congress (RAES) of 2008, the international participation course “Laparoscopy in the acute abdomen” was organized. Since 2013, annual trauma workshops (DSTC ™) and non-traumatic abdominal emergencies have been organized with international participation by CEHB, the surgery clinic, and the UMFCarol Davila Department of Anatomy. CEHB surgeons presented papers at EAES,EATES and ESTES congresses. Of the 1699 laparoscopic operations performed in the clinic in 2018, accounting for 31.27% of the total operations, 493 (29.01%) were in emergency. The SCUB surgeons have had and have a major contribution in preparing the residents, implementing and developing emergency laparoscopy within the miniminvasive therapy, the therapy of the future.

MODERN VIEWS ON THE TREATMENT OF PERFORATED PYLORODUODENAL ULCERS

Summary. Purpose: to improve the results of surgical treatment of patients with perforated pyloroduodenal ulcer. Materials and methods. The results of treatment of 101 patients operated on for perforated pyloroduodenal ulcer, which were treated in the surgical department for the period from 2015 to 2020, were analyzed. Results and discussion. Laparoscopic interventions were performed in 56 (55.4 %) patients with perforated ulcer. Excision of perforated ulcer by traditional laparotomy without vagotomy was used in 26 (25.7 %) patients. Suturing of perforated ulcer by traditional method without vagotomy was performed in 19 (18.8 %) patients. Complications of the early postoperative period in 8 (7.9 %) patients were surgical in nature. In 27 (26.7 %) patients postoperative complications were specific associated with the performance of dilated pyloroduodenoplasty. The largest number of postoperative complications was observed in patients who underwent suturing of the ulcer using traditional laparotomy access – 17 (16.8 %), of which general surgery – 6 (5.9 %), specific – 11 (10.9 %). Conclusions. Laparoscopic suturing of perforated ulcers is accompanied by less pronounced pain, a decrease in the number of postoperative complications, which requires greater use of endovideo-surgical technologies in this complication of peptic ulcer disease.

Diagnosis of perforation from the penetrating ulcer of the posterior wall of the duodenum

The article is devoted to the problem of emergency surgery for abdominal organs – perforated ulcer of the posterior duodenal wall (duodenum). 140 patients with perforated duodenal ulcer were treated at the N.V. Sklifosovsky Research Institute for Emergency Medicine between 2016 and 2019. Eight patients had perforation from the penetrating ulcer of the posterior duodenal wall. The average age of patients with perforation from the penetrating ulcers in the posterior duodenal wall was 62.25 years (27 to 78 years). Most of the cases were found in men – 87.5%. 7 patients had surgery at the Institute, one was transferred from another medical institution where he underwent surgery. Four patients were discharged with a favorable outcome, and four died. Two of the deceased patients had perforation associated with penetrating duodenal ulcer that was diagnosed during laparotomy; in two other cases, perforation associated with the penetrating ulcer was detected only during autopsy. A feature of perforated gastroduodenal ulcers when they are localized on the posterior wall of the duodenum is poor clinical manifestation, which is associated with the entry of duodenal contents into a limited retroperitoneal space, leading to a significant inflammatory process of retroperitoneal tissue. Complex use of X-ray examination, oesophagogastroduodenoscopy, and CT allows to correctly assess and timely diagnose perforation associated with the penetrating ulcer of the posterior wall of the duodenum into the retroperitoneal space.

Laparoscopic management of a late gastric perforation post-fundoplication

Nissen fundoplication is a safe and effective procedure for gastroesophageal reflux. Gastric ulceration leading to perforation is an uncommon late complication with a mechanism of action that is poorly understood. A 40-year-old male presented 3 years following his fundoplication with a perforated ulcer in the upper body of the stomach. The patient admitted ibuprofen use leading up to the perforation. The perforation was successfully repaired via laparoscopy, with good postoperative outcome. Gastric ulcer perforation post-fundoplication is a rare late outcome. Gastric perforation may have been precipitated by the use of non-steroidal anti-inflammatory drugs (NSAIDs) in concert with the vascular mechanical changes caused by this procedure. A review of the literature reveals only a handful of accounts of gastric ulcers or perforations as a late outcome. Of note, many of these perforations occur in the upper stomach and in tandem with NSAID use.