Ulcerul postbulbar perforat

Abstract

Actualitatea: Deși, individualizat de criterii anatomice clare - intersecție cu artera gastroduodenală proximal și unghiul Treitz distal, tema care este pusă în discuție și astăzi, ca regiune a duodenului (D 1-2-3-4), delimitată cranial de artera gastroduodenală și caudal de orificiul papilei și mai jos de acesta, este sediul unde poate apărea ulcerul duodenal postbulbar perforat.Material și metode: Studiul cuprinde un lot de 12 bolnavi, spitalizați de urgență cu suspecție la ulcer postbulbar perforat în perioada 2000-2010. În raport cu numărul bolnavilor operați (692) pentru ulcer duodenal perforat în această perioadă, ulcerul postbulbar reprezintă un indice de 1,73%. În lot s-a constatat un număr de 10 bărbați și 2 femei cu vârsta cuprinsă între 41-60 ani. La internare s-a constatat că durerea și contractura musculară a peretelui abdominal a fost prezentă la 10 din 12 pacienți, iar la 2 bolnavi tabloul clinic, cât și examenul radiologic de ulcer perforat a fost absent.Rezultate: Referindu-ne la localizarea ulcerului postbulbar perforat constatăm că în majoritatea cazurilor leziunea a fost situate pe D1.Dacă la 10 pacienții simptomatologia clinică și radio- endoscopică era caracteristică ulcerului perforat, în 2 cazuri semnele clinice și de laborator au fost necaracteristice perforației ce ne-a impus la un examen suplimentar laparoscopia diagnostică care a constatat ulcer postbulbar perforat acoperit.Intervențiile chirurgicale efectuate la cei 12 pacienții cu ulcer perforat postbulbar au fost simplă suturare – 6 cazuri; excizia ulcerului perforat cu piloroduodenoplastie Judd asociat cu vagotomie tronculară bilaterală 4 cazuri; excizia ulcerului perforat asociat cu vagotomie selectivă proximală – 2 cazuri, cu rezultate bune la distanță. Concluzii: Perforația ulcerului postbulbar duodenal în peritoneal liber este rară și după datele noastre are o pondere de 1,73%.

Actuality: Even though this region is clearly individualized by obvious anatomical criteria - intersection with gastro duodenal artery proximal and distal with the Treitz angle, which is the topic under discussion even today, the region of the duodenum (D 1-2-3-4), limited cranially by gastro duodenal artery and caudal by the papilla hole and below it, this is the area where post bulbar perforated duodenal ulcer can occur.Material and methods: The study includes a group of 12 patients hospitalized in the emergency suspecting post bulbar ulcer, in the period 2000-2010. In relation to the number of patients operated for perforated ulcer (692) during the same period, the post bulbar ulcer has an index of 1.73%. The group was with a total of 10 men and 2 women aged between 41 and 60. In terms of clinical and objective data on admission was found that pain and muscle contraction of the abdominal wall was present in 10 of 12 cases and in 2 cases clinical and radiological signs of the perforated ulcer were absent.Results: Referring to the perforated post bulbar ulcer localization we find that in most cases the lesion was located on the D1 segment. If 10 patients had clinical and radiological signs which indicated a perforated ulcer, in 2 cases clinical and laboratory signs were uncharacteristic for perforation that required us to a supplementary examination which was diagnostic laparoscopy which showed covered post bulbar perforated ulcer.Surgeries performed on the 12 patients with perforated ulcer were simple suturing – 6 cases, perforated ulcer excision with pyloric plasty Judd associated with bilateral nonselective vagotomy – 4 cases, and excision of ulcer perforation associated with selective proximal vagotomy – 2 cases, with good long term result. Deaths were not registered. Conclusions: Perforation of post bulbar ulcer in peritoneum is rare and by our data is 1,73%.

Actuality: Even though this region is clearly individualized by obvious anatomical criteria - intersection with gastro duodenal artery proximal and distal with the Treitz angle, which is the topic under discussion even today, the region of the duodenum (D 1-2-3-4), limited cranially by gastro duodenal artery and caudal by the papilla hole and below it, this is the area where post bulbar perforated duodenal ulcer can occur.Material and methods: The study includes a group of 12 patients hospitalized in the emergency suspecting post bulbar ulcer, in the period 2000-2010. In relation to the number of patients operated for perforated ulcer (692) during the same period, the post bulbar ulcer has an index of 1.73%. The group was with a total of 10 men and 2 women aged between 41 and 60. In terms of clinical and objective data on admission was found that pain and muscle contraction of the abdominal wall was present in 10 of 12 cases and in 2 cases clinical and radiological signs of the perforated ulcer were absent.Results: Referring to the perforated post bulbar ulcer localization we find that in most cases the lesion was located on the D1 segment. If 10 patients had clinical and radiological signs which indicated a perforated ulcer, in 2 cases clinical and laboratory signs were uncharacteristic for perforation that required us to a supplementary examination which was diagnostic laparoscopy which showed covered post bulbar perforated ulcer.Surgeries performed on the 12 patients with perforated ulcer were simple suturing – 6 cases, perforated ulcer excision with pyloric plasty Judd associated with bilateral nonselective vagotomy – 4 cases, and excision of ulcer perforation associated with selective proximal vagotomy – 2 cases, with good long term result. Deaths were not registered. Conclusions: Perforation of post bulbar ulcer in peritoneum is rare and by our data is 1,73%.