Staged Treatment of a Complicated Giant Gastric Ulcer: a clinical case report

Abstract

Introduction. The paper presents clinical outcomes of surgical treatment of a patient with a chronic giant gastric ulcer complicated by penetration into the pancreas, perforation of the anterior and posterior walls of the stomach and general purulent peritonitis. According to various data postoperative mortality in such patients ranges from 11.1% to 50%. In this regard, patients with giant penetrating ulcers need an individual approach and the issue of the optimal amount of surgical intervention still remains challenging. Methods. The damage control method and staged surgical interventions were applied in the treatment of this patient. At the first stage, the perforation hole on the back wall of the stomach was sutured with a double-row interrupted suture, the hole on the front wall was sutured using a pedunculated omentum, and sanitation of the abdominal cavity was performed. Postoperative intensive complex treatment was carried out in the intensive care unit. Results. After two days of treatment a planned relaparotomy (the Billroth II operation modified by Braun-Balfour) with resection of 2/3 part of the stomach was performed. The postoperative macrosection demonstrated that the size of the ulcer was 18.0x10.0 cm. The postoperative period was complicated: the intestinal paresis resolved in 5 days, there was a left lower lobe pleuropneumonia in the lungs suppuration of the postoperative wound. The patient recovered and was discharged in 25 days after hospitalization.