Bleeding from duodenal ulcer in a patient with bilio-pancreatic diversion
| Autor: | Matteo Maternini, Alberto Delitala, Franco Uggeri, Margherita Luperto, Mattia Garancini |
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| Rok vydání: | 2011 |
| Předmět: |
Male
Enteroscopy medicine.medical_specialty Duodenum medicine.medical_treatment Perforation (oil well) Anastomosis Enterotomy Gastroduodenal artery Laparotomy medicine.artery medicine Humans Ligation business.industry Malnutrition Stomach Arteries Middle Aged Biliopancreatic Diversion Gastroenterostomy Surgery Peptic Ulcer Hemorrhage medicine.anatomical_structure Duodenal Ulcer business |
| Zdroj: | Updates in Surgery. 63:297-300 |
| ISSN: | 2038-3312 2038-131X |
| DOI: | 10.1007/s13304-011-0064-9 |
| Popis: | Scopinaro's bilio-pancreatic diversion is considered as an acceptable malabsorptive surgical approach for the treatment of morbid obesity. We describe a case of acute recurrent gastro-intestinal bleeding in a patient with a previous Scopinaro's bilio-pancreatic diversion. At the first admission in our department, gastroscopy, colonoscopy, contrast-enhanced computerized tomography and angiography resulted negative for active bleeding. Hypovolemic shock indicated laparotomy and an intraoperative enteroscopy performed through a small enterotomy showed an ulcerative perforation sourced in an ischemic portion of a distended duodenal stump, with a bleeding branch of gastro-duodenal artery at the bottom. Hemorrhage was stopped with stitches. Two years later a new episode of duodenal bleeding associated with severe malnutrition occurred. A covered chronic ischemic perforation sustained by duodenal distension due to biliopancreatic limb sub-obstruction appeared to be the most probable etiology of the recurrent duodenal bleeding. The patient underwent again to laparotomy and adhesiolysis; hemorrhage was stopped by means of ligation of gastroduodenal artery and bilio-pancreatic diversion was converted into a standard Roux-en-Y gastroenterostomy with an entero-entero anastomosis 40 cm from the Treitz ligament in order to restore an anatomo-functional condition guaranteeing normal absorption and intestinal transit. After Scopinaro's bilio-pancreatic diversion duodenal bleeding can represent a rare serious presentation of biliopancreatic limb obstruction; because of the complex anatomical reconstruction performed during this intervention, the duodenum results unavailable during upper gastro-intestinal endoscopy, and if a duodenal bleeding is suspected laparotomy followed by enteroscopy represents an effective diagnostic approach. |
| Databáze: | OpenAIRE |
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