RETRO-DUODENAL PERFORATES - SURGICAL TREATMENT

Abstract

Retro-duodenal perforations / iatrogenic and ulcerative / fortunately, are a relatively rare surgical problem, but unfortunately, in therapeutic aspect, they are associated with severe complications,and still high lethality. On the other hand, in the last quarter of the century, we have witnessed increasing of possibilities of mini-invasive procedures. In addition to diagnostic value, much of them have a therapeutic character, the latter often have either definitive effect. However, we also encounter new iatrogenic complications that are unknown until this moment. Much of these complications are managed conservatively and do not require aggressive surgical interventions. One of the most difficult for diagnosis and treatment complications are retroduodenal perforations. According to the literature, this complication occurs in a frequency of 2-4% of papilla Vatery's manipulations. With the intensive work at Gastroenterology diagnostic departments at university and district hospitals, the surgeons need to be familiar and ready to diagnose and treat this kind of complication. Surgical treatment in both types of perforations is prevented by the presence of many vital vessels, a nervous network and, on the other hand, retro-duodenal adipose tissue highly susceptible to infection spreading. According to publications in the world literature, a number of methods of treatment are proposed: conservative, less and more invasive, yet still with variable success and considerably extended hospital staying and expensive cost of treatment.