The sixth decision regarding perforated duodenal ulcer

Sandhya Lagoo, Ross L McMahon, Minoru Kakihara, Theodore N Pappas, Steve Eubanks, Sandhya Lagoo, Ross L McMahon, Minoru Kakihara, Theodore N Pappas, Steve Eubanks

Abstract

This presentation reviews the literature regarding the current surgical treatment of perforated ulcers, describes the surgical techniques for laparoscopic repair, and reviews the clinical algorithm used by laparoscopic surgeons at Duke University Medical Center.

Figures

Figure 1.
Figure 1.
Three sutures are placed through viable duodenum on either side of the perforation and tied to close the perforation. Reproduced with permission from Shah AS, Pappas TN. Atlas of Laparoscopic Surgery. In: Pappas TN, Chekan EG, Eubanks S, eds. Laparoscopic Repair of Perforated Ulcer and Vagotomy. Philadelphia, Pa: Current Medicine; 1999.
Figure 2.
Figure 2.
Laparoscopic suturing of a pedicle of omentum placed across the perforation completes the Graham patch. Reproduced with permission from Shah AS, Pappas TN. Atlas of Laparoscopic Surgery. In: Pappas TN, Chekan EG, Eubanks S, eds. Laparoscopic Repair of Perforated Ulcer and Vagotomy. Philadelphia, Pa: Current Medicine; 1999.
Figure 3.
Figure 3.
Repair of duodenal perforation with omentopexy alone. Reproduced with permission from Baker RJ. Mastery of Surgery. In: Nyhus LM, Baker RJ, Fischer JE, eds. Operation for Acute Perforated Duodenal Ulcer. London: Little, Brown and Company; 1997.
Figure 4.
Figure 4.
A. Suture repair of viable opposable edges of the duodenal perforation and reinforcement with an omental patch. B. Omentum plugs the hole of the perforation. Reproduced with permission from Baker RJ. Mastery of Surgery. In: Nyhus LM, Baker RJ, Fischer JE, eds. Operation for Acute Perforated Duodenal Ulcer. London: Little, Brown and Company; 1997.
Figure 5.
Figure 5.
The Duke Medical Center algorithm for management of a suspected perforated duodenal ulcer.

References

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