Post-bulbar duodenal ulcer with anterior perforation with kissing ulcer and duodenocaval fistula:A case report and review of literature  

作　　者：Nasser Alzerwi 

机构地区：[1]Department of Surgery,College of Medicine,Majmaah University,Riyadh 66,Riyadh,Saudi Arabia

出　　处：《World Journal of Clinical Cases》2022年第25期9071-9077,共7页世界临床病例杂志

摘　　要：BACKGROUND A post-bulbar duodenal ulcer(PBDU)is an ulcer in the duodenum that is distal to the duodenal bulb.PBDU may coexist with a synchronous posterior ulcer in rare occurrences,resulting in a kissing ulcer(KU).Duodenocaval fistula(DCF)is another uncommon but potentially fatal complication related to PBDU.There is limited knowledge of the scenarios in which PBDU is complicated by KU and DCF simultaneously.CASE SUMMARY A 22-year-old man was admitted to the emergency department with abdominal pain,stiffness,and vomiting.The X-ray showed pneumoperitoneum,suggesting a perforated viscus.Laparotomy revealed a KU with anterior perforation and a DCF.After Kocherization,venorrahphy was used to control caval bleeding.Due to the critical condition of the patient,only primary duodenorrahphy with gastrojejunostomy was performed as a damage control strategy.However,later,the patient developed obstructive jaundice and leakage,and two additional jejunal perforations were detected.Due to the poor condition of the duodenum and the involvement of the ampulla in the posterior ulcer,neither primary repair nor pancreatic-free duodenectomy and ampull-oplasty/ampullary reimplantation were considered viable;therefore,an emergency pancreaticoduodenectomy was performed,along with resection and anastomosis of the two jejunal perforations.The patient had a smooth recovery after surgery and was discharged after 27 d.CONCLUSION The timely diagnosis of PBDU and radical surgery can aid in the smooth recovery of patients,even in the most complex cases.

关 键 词：Duodenal ulcer Duodenocaval fistula Kissing ulcer Emergency Whipple’s surgery Case report 

分 类 号：R656.64[医药卫生—外科学]