Combined complications of duodenal ulcer: classification and some aspects of pathogenesis and tactics of surgical treatment

Abstract

Aim. To improve the existing classifications as the basis for the development of a pathogenetically substantiated treatment and diagnostic tactics that meets the modern requirements of surgical gastroenterology. Material and methods. The material is based on the results of diagnosis and surgical treatment of 658 patients with duodenal ulcerative colitis with combined complications. A combination of two or more complications occurred: stenosis + penetration - in 368 (55.9 %) patients, penetration + stenosis + bleeding - in 105 (16.0 %), penetration + stenosis + perforation - in 58 (8.8 %) ), perforation + bleeding - in 52 (7.9 %), perforation + penetration - in 18 (2.7 %), penetration + bleeding - in 51 (7.8 %) patients, a combination of multiple and rare complications - in 6 (0.9 %) patients, including penetration + stenosis + perforation + bleeding - in 1 (0.15 %) patient, a combination of penetration, stenosis and duodenocholedochal fistula - in 3 (0.45 %), a combination of penetration + bleeding + stenosis + chronic pancreatitis - in 1 (0.15%), a combination of penetration + choledochal stricture + obstructive jaundice - in 1 (0.15%) patient. Results and discussion. In the classification of each variant of combined complications, the main factors influencing the choice of treatment tactics are identified. The choice of the method of surgical treatment with a simultaneous combination of several complications, first of all, depends on the general condition of the patients, due to the severity of bleeding, the prevalence of peritonitis, and the stage of stenosis of the gastroduodenal junction. In emergencies, only intraoperative revision makes it possible to clarify the nature of the pathological process and the possibility of its elimination by radical or palliative methods. Conclusion. The proposed classification can become a new platform for conducting a pathogenetically substantiated diagnostic and therapeutic strategy with the possibility of improving the results of surgical treatment of patients with duodenal ulcerative colitis with combined complications.