Korean J Gastroenterol.  2018 Nov;72(5):262-266. 10.4166/kjg.2018.72.5.262.

Covered Self-expandable Metallic Stent Insertion as a Rescue Procedure for Postoperative Leakage after Primary Repair of Perforated Duodenal Ulcer

• Yoo YJ
• Lee YK
• Lee JH
• Lee HS

• KMID: 2426868
• DOI: http://doi.org/10.4166/kjg.2018.72.5.262

Abstract

Surgery has been the standard treatment for perforated duodenal ulcers, with mostly good results. However, the resolution of postoperative leakage after primary repair of perforated duodenal ulcer remains challenging. There are several choices for re-operation required in persistent leakage from perforated duodenal ulcers. However, many of these choices are complicated surgical procedures requiring prolonged general anesthesia that may increase the chances of morbidity and mortality. Several recent reports have demonstrated postoperative leakage after primary repair of a perforated duodenal ulcer treated with endoscopic insertion using a covered self-expandable metallic stent, with good clinical results. We report a case with postoperative leakage after primary repair of a perforated duodenal ulcer treated using a covered self-expandable metallic stent.

Keyword

Duodenal ulcer; Peptic ulcer perforation; Self expandable metallic stents

MeSH Terms

Anesthesia, General
Duodenal Ulcer*
Mortality
Peptic Ulcer Perforation
Self Expandable Metallic Stents
Stents*

Figure

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  Fig. 1 Preoperative endoscopic examination demonstrating a 3-cm-sized ulcer perforation at the first portion of the duodenum covered by yellowish debris tissue.

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  Fig. 2 Abdomen X-ray findings and esophagogastroduodenoscopy before SEMS insertion. (A) The diatrizoate sodium and diatrizoate meglumine solution procedure demonstrating leakage in the primary repair site of the duodenal ulcer perforation. (B) Esophagogastroduodenoscopy showing a huge ulcer in the first portion of the duodenum with suture material and absorbable polyglycolic acid sheet. SEMS, self-expandable metallic stent.

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  Fig. 3 Esophagogastroduodenoscopy and abdomen X-ray findings after SEMS insertion. (A) The SEMS covered with the leakage site of the duodenum. (B) The SEMS is located at the first portion of the duodenum (arrow). SEMS, self-expandable metallic stent.

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  Fig. 4 Change in the negative suction drain amount after SEMS insertion. SEMS, self-expandable metallic stent.

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