| Popis: |
BACKGROUND: Retro-duodenal perforations / iatrogenic and ulcerative / fortunately, are a relatively rare surgical problem, but unfortunately, in therapeutic aspect, they are associated with severe complications, and still high lethality. MATERIAL AND METHODS: The subject of study was two groups of patients: in the first, we included patients with gastroduodenal perforations of peptic ulcer. In the second one-the patients were presented with iatrogenic perforations of the duodenum, after endoscopic manipulations on the papilla of Vater. We conduct a retrospective analysis of 5 years period (2011-2015), 6,339 patients underwent surgical operations at the University Hospital "Department of Bilio-Pancreatic Surgery". 15 /0.23%/ cases were included in the first group- patients with retroduodenal perforation of duodenal ulcer. For the reporting period, a total of 365 patients were indicated to this manipulation: bilio-pancreatitis 78 patients, 74 with mechanical jaundice, 137 with different forms of the biliary-stone disease, 6 with cholangitis and 9 with tumours of extrahepatic bile duct and papilla of Vater. RESULTS: In 15 cases we had a retroduodenal perforation of ulcers, three death cases in this group –( 20%). In the second group of patients we had 3 cases with Iatrogenic retroduodenal perforation, 2 of them dyed, and lethality was 67% in that group. We performed laparotomy for pyloric occlusion with gastro-jejuno anastomosis and Brown’s anastomosis with adequate drainage of retroduodenal space. We inserted two tubes: first for aspiration in the proximal direction in the lumen of the duodenum; the second tube is double lumen nutritional tube. CONCLUSION: Retroduodenal perforations, in our opinion, are subject to emergency surgical treatment at the time of their diagnosis. Surgical treatment is obligatory. |
