Abstract
Laparoscopic repair of perforated duodenal ulcers is safe and effective in centers with experience and increasingly performed by laparoscopic surgeons. However, the role of laparoscopy for the management of large duodenal perforations (>1 cm) is unclear. To date, no experience has been reported with emergency laparoscopic repair of large perforations for gastroduodenal ulcers. The commonest reason for conversion to open surgery is a perforation size of more than 1 cm. This paper reports a case of a large duodenal perforation due to a nasogastric tube in a 26-year-old male who had undergone a tracheostomy, following a cut-throat injury. This large perforation was successfully diagnosed and repaired laparoscopically. This is probably the first paper in the English literature to report duodenal perforation due to a nasogastric tube in an adult and also the first report of a successful laparoscopic repair of a large duodenal perforation.
Highlights
Laparoscopic repair of perforated duodenal ulcers is safe and effective in centers with experience and increasingly performed by laparoscopic surgeons
A consensus conference recently reported that laparoscopic repair of perforated gastric and duodenal ulcers is safe and effective in centers with experience, and to date no experience has been reported with emergency laparoscopic repair of large perforations [2]
The present paper reports a case of a large duodenal perforation in a tracheotomiced adult, caused by an indwelling feeding nasogastric tube, which was managed laparoscopically
Summary
Laparoscopic repair of perforated duodenal ulcers is safe and effective in centers with experience and increasingly performed by laparoscopic surgeons. A consensus conference recently reported that laparoscopic repair of perforated gastric and duodenal ulcers is safe and effective in centers with experience, and to date no experience has been reported with emergency laparoscopic repair of large perforations [2]. In all these studies analyzed for the laparoscopic technique, the patients had small ulcers (mean diameter of 1 cm) and all the patients received simple suture, mostly with omental patch, or sutureless repair. The present paper reports a case of a large duodenal perforation in a tracheotomiced adult, caused by an indwelling feeding nasogastric tube, which was managed laparoscopically. The paper discusses the potential complications of gastrointestinal intubation and diagnostic role of laparoscopy in such situations and its possibility in management of large duodenal perforations
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