Acute Gastroduodenal Bleeding Research Articles

Multiple complications of postbulbar parapapillary ulcer combined with arteriomesenteric compression of the duodenum

The article explores a clinical observation of a giant postbulbar parapapillary duodenal ulcer with multiple combined complications in the form of penetration into the pancreas, acute gastroduodenal bleeding and subcompensated stenosis occurred against the background of arterio-mesenteric compression of the duodenum in the subcompensation stage. The long course of the disease contributed to the development of alimentary dystrophy, cachexia and severe anemia. After stopping the bleeding, carrying out adequate preoperative preparation, the patient underwent Roux-en-Y gastric resection to “turn off” the ulcer with demucosation of the antrum and formation of the epipyloric stump of the duodenum according to the method modified in the clinic. The postoperative period was complicated by the development of a fistulous variant of duodenal stump suture failure, which was conservatively eliminated. The patient recovered.

СОВРЕМЕННЫЕ ПОДХОДЫ К ЛЕЧЕНИЮ ГАСТРОДУОДЕНАЛЬНЫХ КРОВОТЕЧЕНИЙ В НЕОТЛОЖНОЙ ХИРУРГИИ В СПЕЦИАЛИЗИРОВАННОМ ГОРОДСКОМ ЦЕНТРЕ

Background. Gastroduodenal bleeding (GDB) is one of the most urgent problems of emergency abdominal surgery. The frequency of detection of bleeding of non-ulcer origin, which in the past was practically not diagnosed, has increased recently due to the widespread introduction of high-tech diagnostic techniques into clinical surgical practice. Diagnostic and therapeutic algorithms for GDB of ulcerative and non-ulcerative etiology are quite clearly defined, but the problem remains relevant due to the fact that the number of patients with acute GDB does not tend to decrease. The tactics of treating bleeding requiring emergency surgery remain debatable. Purpose. To evaluate the results of treatment of gastroduodenal bleeding of ulcerative and non-ulcerative origin requiring emergency surgery performed in a specialized city center for gastroduodenal bleeding. Material and methods. The experience of emergency care and treatment of 1061 patients with GDB in a specialized center is presented. Results. FGDS was performed on admission in all patients; ulcer bleeding was diagnosed in 809 (76.2%) patients; non-ulcer bleeding in 252 (23.8%) patients. Bleeding from gastric ulcers was detected in 227 (30.3%) patients, from duodenal ulcers – in 582 (69.7%) patients. Endohemostasis was performed for continued bleeding during FGDS. The treatment was based on the generally accepted complex of conservative therapy according to the clinical protocols for managing patients with GDB. Сonclusion. An analysis of the results of treatment of patients hospitalized in the city center for GDB showed that at the present stage endohemostasis is effective in 98.4% of ulcer bleeding and in 96.0% of non-ulcer bleeding.

New technologies of endoscopic hemostasis in a treatment protocol of patients with gastroduodenal ulcer bleeding

Relevance of research. Acute gastroduodenal bleeding is remaining a difficult and largely unsolved problem up to day. The fundamental importance in treating this category of patients is an endoscopic hemostasis. The decisive point in this problem is the most stable hemostasis and preventing a recurrence of a hemorrhage. In this regard, the search of new solutions and the development of known methods of treatment of the gastroduodenal ulcer bleeding is an important issue.
 
 Aim of research. To evaluate the effectiveness of the treatment protocol of patients with the gastroduodenal ulcer bleeding by applying combined endoscopic insufflations of hemostatic agents and a diovin as an integral part of a complex therapy.
 
 Materials and methods. The research is based on results of treatment of the patients with the gastroduodenal ulcer bleeding being in a medical setting at the departments of surgery at Voronezh city clinical emergency hospital №1. During the treatment of the main group (59 patients) there was used an integrated approach with the usage of powdered hemostatic agents of gelplastan and lyophilisate NovoSeven in combination with diovin in the endoscopic treatment of gastroduodenal ulcer bleeding. There were used the traditional well-known methods of the endoscopic hemostasis without the usage of hemostatic agents and absorbent grains in treatment of the control group (56 patients).
 
 Results and discussion. The evaluation of results of patients’ treatment with gastroduodenal ulcer bleeding was performed according to the figures of the final hemostasis, the frequency of recurrent bleeding, the prevention of emergency operations, the rates of mortality, the duration of hospitalization. The developed protocol of the patients’ treatment with gastroduodenal ulcer bleeding with the usage of combined the endoscopic insufflation of two hemostatics and diovin makes it possible to achieve the maximum persistent hemostasis at 94.9% of patients, to reduce the risk of recurrent hemorrhages by 2.5 times, to prevent emergency operations and, as a result, to reduce the lethality.
 
 Conclusion. The usage of new technologies of endoscopic hemostasis by the hemostatic pneumoinsufflation gelplastan and lyophilisate NovoSeven in combination with diovin in the treatment of patients with gastroduodenal ulcer bleeding allows to reduce the risk of recurrent hemorrhage from 12,5% to 5,01% (by 2,5 times), to prevent emergency operations, to reduce the lethality from 3,65% to 1,7% (by 2,1 times) and to reduce the period of staying in the hospital from 10,2 to 7,4 bed days (p<0.05).