Controlled tube duodenostomy in the management of giant duodenal ulcer perforation: a new technique for a surgically challenging condition

Pawanindra Lal, Anubhav Vindal, N S Hadke
American Journal of Surgery 2009, 198 (3): 319-23

BACKGROUND: Giant duodenal ulcer (GDU) perforation remains an extremely uncommon but a rather challenging condition to manage wherein routine surgical procedures are fraught with an extremely high incidence of failure and mortality. It therefore follows that this condition must be identified and managed differently at laparotomy than are most duodenal perforations. We describe a method by which to deal with this condition using triple-tube-ostomy.

METHODS: In a prospective setting, 20 patients underwent surgery using the technique described in the article. During the same period, 20 patients with GDU perforation, who were managed in the conventional manner, were evaluated. The outcomes of the 2 groups were compared.

RESULTS: The success rate was 100% in the study group compared with 30% in the control patients.

CONCLUSIONS: Based on the ease of the technique and the high success of the procedure in our experience in this select group, we recommend this procedure for the management of GDU perforation as a safe, reliable, and easy technique to learn.

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