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Technique to manage persistent leak from a prepyloric ulcer where a distal gastrectomy is not appropriate

Perforated peptic ulcer disease remains a relatively frequent emergency surgery presentation. Persistent leak is the most common indication for return to theatre. We present a technique to manage patients in whom a more substantial resection is not possible. A 45-year-old woman underwent initial lap...

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Detalles Bibliográficos
Autores principales: Bowling, Kirk, Balcombe, Alison, Rait, Jaideep, Andrews, Stuart
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Oxford University Press 2015
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4531221/
https://www.ncbi.nlm.nih.gov/pubmed/26265682
http://dx.doi.org/10.1093/jscr/rjv103
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author Bowling, Kirk
Balcombe, Alison
Rait, Jaideep
Andrews, Stuart
author_facet Bowling, Kirk
Balcombe, Alison
Rait, Jaideep
Andrews, Stuart
author_sort Bowling, Kirk
collection PubMed
description Perforated peptic ulcer disease remains a relatively frequent emergency surgery presentation. Persistent leak is the most common indication for return to theatre. We present a technique to manage patients in whom a more substantial resection is not possible. A 45-year-old woman underwent initial laparoscopic primary closure of a non-malignant perforated gastric ulcer. This subsequently leaked on return to the UK and had a further graham patch formed via a laparotomy. Unfortunately, the patch repair leaked and at reoperation a wedge excision or distal gastrectomy was not possible given the friability of the tissues and instability of the patient, a transgastric drain and perigastric drain were therefore placed. This created a controlled fistula, which was managed eventually as an outpatient. Transgastric drains in the context of the persistent perforated gastric ulcer leak are a safe way to manage the unstable patient with poor tissues where more substantial surgeries such as a distal gastrectomy are not possible.
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spelling pubmed-45312212015-08-12 Technique to manage persistent leak from a prepyloric ulcer where a distal gastrectomy is not appropriate Bowling, Kirk Balcombe, Alison Rait, Jaideep Andrews, Stuart J Surg Case Rep Case Reports Perforated peptic ulcer disease remains a relatively frequent emergency surgery presentation. Persistent leak is the most common indication for return to theatre. We present a technique to manage patients in whom a more substantial resection is not possible. A 45-year-old woman underwent initial laparoscopic primary closure of a non-malignant perforated gastric ulcer. This subsequently leaked on return to the UK and had a further graham patch formed via a laparotomy. Unfortunately, the patch repair leaked and at reoperation a wedge excision or distal gastrectomy was not possible given the friability of the tissues and instability of the patient, a transgastric drain and perigastric drain were therefore placed. This created a controlled fistula, which was managed eventually as an outpatient. Transgastric drains in the context of the persistent perforated gastric ulcer leak are a safe way to manage the unstable patient with poor tissues where more substantial surgeries such as a distal gastrectomy are not possible. Oxford University Press 2015-08-11 /pmc/articles/PMC4531221/ /pubmed/26265682 http://dx.doi.org/10.1093/jscr/rjv103 Text en Published by Oxford University Press and JSCR Publishing Ltd. All rights reserved. © The Author 2015. http://creativecommons.org/licenses/by-nc/4.0/ This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. For commercial re-use, please contact journals.permissions@oup.com
spellingShingle Case Reports
Bowling, Kirk
Balcombe, Alison
Rait, Jaideep
Andrews, Stuart
Technique to manage persistent leak from a prepyloric ulcer where a distal gastrectomy is not appropriate
title Technique to manage persistent leak from a prepyloric ulcer where a distal gastrectomy is not appropriate
title_full Technique to manage persistent leak from a prepyloric ulcer where a distal gastrectomy is not appropriate
title_fullStr Technique to manage persistent leak from a prepyloric ulcer where a distal gastrectomy is not appropriate
title_full_unstemmed Technique to manage persistent leak from a prepyloric ulcer where a distal gastrectomy is not appropriate
title_short Technique to manage persistent leak from a prepyloric ulcer where a distal gastrectomy is not appropriate
title_sort technique to manage persistent leak from a prepyloric ulcer where a distal gastrectomy is not appropriate
topic Case Reports
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4531221/
https://www.ncbi.nlm.nih.gov/pubmed/26265682
http://dx.doi.org/10.1093/jscr/rjv103
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