Perforated Gastric Ulcer Research Articles

Tactic of prognostication of adhesive process after time-urgen gynaecological operations

The objective: study of dependence of expressed of adhesive process for gynaecological patients taking into account an amount and volume of previous operations. Materials and methods. For the decision of the put purpose inspected and conducted surgical treatment laparoscopic access for 304 patients which carried before operative interferences on the organs of abdominal region and small pelvis. All patients were up-diffused on 3 groups depending on an amount and character of the carried operations. a 1 group (n=159) was made by patients with one чревосечением in anamnesis after gynaecological operations. 2 a group (n=99) is women with two чревосечениями in anamnesis. Gynaecological, surgical interferences or their combinations took place in this group. Patients (n=46) which have in anamnesis 3 and more чревосечений (n=30), and also women (n=16) which carried operative interferences concerning the poured out festering peritonitis, entered in 3 groups, intestinal impassable and perforated gastric ulcers. Results. Operative interferences are carried by an important factor which results in formation of joints in to the small pelvis. Shown of спаечного process in small to the pelvis had straight proportional dependence on the amount of чревосечений. Among all patients which had in anamnesis a conservative myomectomy in combination with a caesarian section or hysterectomy, the adhesive process of organs of small pelvis appeared most expressed. Conclusion. The factors leading to formation of solderings in a small basin, the transferred operative interventions are. The risk of development and expressiveness of postoperative unions are in direct dependence on quantity laparotomy in the anamnesis. Forecasting the instructions on two and more gynecologic interventions, in a greater degree radical operations on a uterus are adverse. The received results are necessary for using by tactics working out laparocopical treatments of gynecologic patients.

Meckel\u2019s diverticulum with intraperitoneal hemorrhage in a child detected with screening laparoscopy: a case report

BackgroundThe most common presentation of symptomatic Meckel’s diverticulum (MD) are intestinal obstruction, gastrointestinal hemorrhage, and inflammation of the MD with or without perforation. Intraperitoneal hemorrhage because of MD is extremely rare. We report a case of MD with intraperitoneal hemorrhage in a child detected with screening laparoscopy.Case presentationAn 11-year-old girl presented to another hospital with lower abdominal pain and vomiting that lasted for 2 days. Acute appendicitis was suspected, and she was referred to our department. Abdominal enhanced computed tomography showed an abscess in the lower abdomen with ascites in the pelvis. She was diagnosed with a localized intra-abdominal abscess and the decision was made to treat with antibiotics. However, her abdominal pain worsened, with abdominal distension, tenderness and guarding. She was diagnosed with panperitonitis and the decision was made for surgery 5 h after admission. During surgery, laparoscopic observation from the umbilical region revealed 200 ml of fresh blood throughout the peritoneal cavity, originating from the mesentery of the ileum. MD was observed with bleeding from the surrounding mesentery. Small bowel resection was performed, and the patient was discharged on the 5th postoperative day. Pathological findings revealed an MD containing ectopic gastric mucosa and small intestinal ulcer perforation at the base of the MD.ConclusionsWe report an extremely rare case of an MD with intraperitoneal hemorrhage in a child. In pediatric cases, it is possible that perforation with ectopic gastric mucosa may cause massive bleeding because of rupture of the surrounding mesenteric blood vessels.

794 Diagnostic Pitfall in Atypical Presentation of Malignant Gastric Ulcer Perforation

Abstract Background Peptic ulcer perforation is one of the most common surgical problems in daily practice. Although it can be easily diagnosed clinically, the clinical presentation can be less obvious in some cases leading to diagnostic pitfalls and mortality. This case report aims to highlight an atypical presentation of malignant gastric ulcer perforation in a patient with chronic abdominal pain. Case presentation A 78-year-old lady presented with chronic abdominal pain for 3 months. Investigations and imaging revealed T2N1M0 malignant gastric ulcer which was confirmed by endoscopy. Due to her low body mass index and underlying comorbidities, she was admitted for pre-operative optimization. However, she was a good 78 with the clinical frailty scale 4 and the National Early Warning Score 0 throughout the stay. On the night before the operation, she suddenly developed delirium. Further history revealed marked oliguria for 12 hours. There was mild abdominal distension without peritonism. She was catheterized and treated with fluids and antibiotics. X-ray suggested massive pneumoperitonium. Subsequently, she developed full-blown septic shock with rapid clinical deterioration within 3 hours. With the estimated Boey scoring of 3 and rapid clinical deterioration, the symptom control approach was decided. A palliative bedside ascitic tap was performed to relieve the discomfort. Four hours after the onset, unfortunately, the patient passed away. Conclusions Although gastric ulcer perforation usually presents with obvious symptoms, extra precaution should be exercised in elderly patients with chronic abdominal pain and comorbidities. We could learn that routine monitoring of urine output might aid in the early diagnosis of sepsis.

AN ALTERNATIVE ROUTE OF TREATMENT FOR REFRACTORY VASODILATORY SHOCK DUE TO THYROID STORM

TOPIC: Critical Care TYPE: Fellow Case Reports INTRODUCTION: Thyroid storm is a rare life-threatening thyrotoxicosis accounting for 16.2% of hospital admissions involving hyperthyroidism. Mortalities rates in thyroid storm have been found to be between 8-25%. This case involves a patient in refractory vasodilatory shock from thyroid storm requiring rectal propylthiouracil (PTU) with rapid resolution of shock. CASE PRESENTATION: 54-year-old woman with history of thyrotoxicosis secondary to Grave's disease, persistent atrial fibrillation, heart failure with reduced ejection fraction, polysubstance abuse, presented initially with dyspnea and tachycardia, found to be in atrial fibrillation with rapid ventricular response and thyrotoxicosis. She reported not taking her home medications for two weeks prior to admission as well as using cocaine intermittently. Her Burch-Wartofsky score was 65, consistent with thyroid storm. She was initially started on oral cholestyramine, methimazole, propranolol, SSKI drops, and intravenous hydrocortisone. Within eight hours of her admission she decompensated requiring multiple vasopressors and transfer to intensive care. On hospital day three she was started on rectal propylthiouracil (PTU) due to a concern for inadequate oral absorption while on four high dose vasopressors. Within 24 hours of receiving rectal PTU she needed minimal norepinephrine to maintain a normal mean arterial pressure. Two weeks later she underwent an I-131 radioactive iodine ablation and was subsequently discharged home. DISCUSSION: Treatment of thyrotoxicosis involves blocking thyroid hormone synthesis, release, conversion of T4 to T3, and decreasing the systemic effects. Majority of therapies available require oral absorption and are not always readily available in intravenous formulations. A study by Jongjaroenprasert et al. reported the successful treatment of fifteen clinic patients with hyperthyroidism using rectal administration of PTU. Prior to this study administration of rectal PTU had been given ten times in the literature. A case report published in 2006 presented a patient with thyrotoxicosis complicated by a perforated gastric ulcer who was successfully treated with rectal PTU. Intravenous formulations of both PTU and methimazole are also potential possibilities to explore should oral options be inadequate, but these are not often available. If the patient presented in this case continued to deteriorate, or developed toxicities from PTU, she would have been started on therapeutic plasma exchange (TPE). While the therapy has limited evidence to support TPE in thyroid storm, American Society for Apheresis recommends initiating TPE if first or second line medical therapies fail within 24-48 hours of treatment. CONCLUSIONS: Rectal PTU is a practical alternative and can be safely administered in critically ill patients in refractory vasodilatory shock. REFERENCE #1: Galindo, R.J., et al., National Trends in Incidence, Mortality, and Clinical Outcomes of Patients Hospitalized for Thyrotoxicosis With and Without Thyroid Storm in the United States, 2004-2013. Thyroid, 2019. 29(1): p. 36-43. REFERENCE #2: Jongjaroenprasert, W., et al., Rectal administration of propylthiouracil in hyperthyroid patients: comparison of suspension enema and suppository form. Thyroid, 2002. 12(7): p. 627-31. REFERENCE #3: Zweig, S.B., et al., Rectal administration of propylthiouracil in suppository form in patients with thyrotoxicosis and critical illness: case report and review of literature. Endocr Pract, 2006. 12(1): p. 43-7. DISCLOSURES: No relevant relationships by Hannah Leschorn, source=Web Response No relevant relationships by Seema tekwani, source=Web Response No relevant relationships by Amanda Wiggins, source=Web Response

Perforated Peptic Ulcer Combined with Posttraumatic Diaphragmatic Hernia in Third Gestation Trimester: a Clinical Case

Background. Gastric and duodenal ulcers are extremely rare in pregnancy, according to published literature. Peptic ulcer is found in 1 per 4,000 pregnant women, a figure probably underestimated due to its hampered diagnosis in pregnancy. Pregnancy peptic ulcer is considered less expected. Perforated gastric and duodenal ulcers comprise about 1.5 % of total acute abdominal diseases, and the perforation rate in ulcer patients ranges within 5–15 %. This complication afflicts the ages of 20–40 years in men much more frequently than in women. Three perforation types occur: free into abdominal cavity (87 %), contained (9 %), into lesser omentum and retroperitoneal tissue (4 %).Materials and methods. The clinical case describes surgical management of posttraumatic diaphragmatic hernia-comorbid perforated gastric ulcer in a pregnant woman in third trimester. Surgery with postoperative patient management enabled for a favourable outcome.Results and discussion. Perforation-entailing gastric and duodenal ulcers in pregnant women have received negligible attention due to rarity in clinical practice. Paul et al. described 14 cases of duodenal perforation in pregnancy, all fatal.Conclusion. Early diagnosis of surgical pathology during gestation is still difficult contributing to the development of severe complications associated with high mortality. The patient’s admission to a level III interspecialty hospital was key to enable a timely consilium-driven decision of caesarean intervention for saving the child, diagnosing intraoperatively life-threatening complicated surgical diseases and opting for radical surgery that ended in a favourable outcome.

Peptic Ulcer Perforation: An Enigma Since Antiquity

Peptic ulcer disease (PUD) is a serious medical condition. The perforation of peptic ulcers (PPU) causes a steep rise in mortality and morbidity. It accounts for 70% of deaths associated with PUD. More than 60% of perforations occur in the anterior wall of the duodenum, while 20% of it is in the antrum. The gastric ulcer perforation contributes to approximately 20% and is in lesser curvature. The risk factor includes non-steroidal anti-inflammatory drugs (NSAID), Helicobactor pylori (H. Pylori), smoking, alcoholism, Corticosteroid, and stress are some of the risk factors. There is a change in the epidemiology of PUD recently. The improvement is remarkable and is due to improved socio-economic status, identification and treatment of Helicobacter pylori, and introduction of proton pump inhibitors. The H pylori infection remains one of the most important causes of PUD and its complications like PPU. The reason for reviewing and writing this paper is to evaluate the most common ideas on the treatment of peptic ulcer perforation, opinion on conservative treatment, and surgical treatment options.

CORRELATION BETWEEN CANDIDIASIS AND MORTALITY IN GASTRIC ULCER PERFORATION PATIENTS

Background: Gastric ulcer disease remains the most common gastrointestinal disease. This affects about 4 million people every year worldwide with an incidence of 1.5%-3% and 2-14% of these will progress to perforation. Mortality is reported in 30% of cases and caused morbidity in 50% of patients. Some studies have suggested that mortality in patients with peritonitis accompanied by candidiasis ranges from 20%-75%, whereas others have argued that the presence of fungal isolates in patients with perforated peptic ulcer does not affect the outcome. A recent study reported an incidence of 45% of patients peptic ulcer perforation cases accompanied by candidiasis in Dr. Soetomo General Hospital Surabaya in 2019.Methods: This was a cross sectional study based on medical record data of patients with gastric ulcer perforation accompanied by candidiasis who underwent laparotomy and gastric repair surgery at Dr. Soetomo General Hospital Surabaya from January 2019 to December 2020.Results: There was no significant correlation between candidiasis and mortality in gastric ulcer perforation patients (p=0.989).Conclusion: Candidiasis does not increase mortality in patients with gastric ulcer perforation.

Correlation Between Candidiasis And Mortality In Gastric Ulcer Perforation Patients

Background: Gastric ulcer disease remains the most common gastrointestinal disease. This affects about 4 million people every year worldwide with an incidence of 1.5%-3% and 2-14% of these will progress to perforation. Mortality is reported in 30% of cases and caused morbidity in 50% of patients. Some studies have suggested that mortality in patients with peritonitis accompanied by candidiasis ranges from 20%-75%, whereas others have argued that the presence of fungal isolates in patients with perforated peptic ulcer does not affect the outcome. A recent study reported an incidence of 45% of patients peptic ulcer perforation cases accompanied by candidiasis in Dr. Soetomo General Hospital Surabaya in 2019.Methods: This was a cross sectional study based on medical record data of patients with gastric ulcer perforation accompanied by candidiasis who underwent laparotomy and gastric repair surgery at Dr. Soetomo General Hospital Surabaya from January 2019 to December 2020.Results: There was no significant correlation between candidiasis and mortality in gastric ulcer perforation patients (p=0.989).Conclusion: Candidiasis does not increase mortality in patients with gastric ulcer perforation.

Correlation Between Candidiasis And Mortality In Gastric Ulcer Perforation Patients

Background: Gastric ulcer disease remains the most common gastrointestinal disease. This affects about 4 million people every year worldwide with an incidence of 1.5%-3% and 2-14% of these will progress to perforation. Mortality is reported in 30% of cases and caused morbidity in 50% of patients. Some studies have suggested that mortality in patients with peritonitis accompanied by candidiasis ranges from 20%-75%, whereas others have argued that the presence of fungal isolates in patients with perforated peptic ulcer does not affect the outcome. A recent study reported an incidence of 45% of patients peptic ulcer perforation cases accompanied by candidiasis in Dr. Soetomo General Hospital Surabaya in 2019.Methods: This was a cross sectional study based on medical record data of patients with gastric ulcer perforation accompanied by candidiasis who underwent laparotomy and gastric repair surgery at Dr. Soetomo General Hospital Surabaya from January 2019 to December 2020.Results: There was no significant correlation between candidiasis and mortality in gastric ulcer perforation patients (p=0.989).Conclusion: Candidiasis does not increase mortality in patients with gastric ulcer perforation.

Giant posterior gastric perforation in a 40 years old male: a case report

Posterior perforation of gastric ulcer is a rare clinical entity and has a propensity for delayed presentation and missed diagnosis. By virtue of their location, posterior gastric perforations may rupture into the retroperitoneum which leads to abscess formation and development of adhesions and consequently, leads to a delay in the onset of symptoms. Alternatively, ulcers located in the fundus or the body of the stomach may perforate into the lesser sac, which results in sealing off the perforation and less dramatic clinical signs and symptoms. This delay in presentation contributes to higher morbidity, higher infection rates and higher mortality. Thus, it is essential to have a high index of suspicion for this condition, particularly in patients with a protracted clinical presentation and classical risk factors so that timely, life-saving intervention is possible. We report a case of giant posterior gastric perforation with benign histopathology in a 40-years-old male. This case is being presented due to the rarity of this clinical entity and the relative paucity of literature on the same.

Intestinal Obstruction Secondary to Multiple Gastrointestinal phytobezoars, A Rare presentation.

IntroductionIntestinal obstruction considered to be one of the most common surgical presentation. Adhesions secondary to previous operations, hernias, neoplasms, inflammatory bowel disease, intussusception, or volvulus are the usual causes of intestinal obstruction but bezoar can presents in 0.4-4%. Bezoar can be trapped in different locations throughout the gastrointestinal tract and it can be solitary or multiple lesions.Case presentationThis is a 37-year-old male, known case of diabetes mellitus, Presented to the Emergency Department complaining of generalized abdominal pain for 2 days duration. Associated with abdominal distention, fever, nausea, vomiting and obstipation. There was a history of persimmon intake. Unremarkable past surgical history. On examination, He was tachycardic, other vital signs were within normal. Abdominal examination showed abdominal distention and Sluggish bowel sound. Abdominal X-ray revealed multiple air-fluid levels. An abdominal CT scan with IV contrast revealed an intra-luminal mass in the ileum and intra-gastric mass with suspicious of bezoars. He underwent exploratory laparotomy, gastrostomy to remove intra-gastric bezoar, and enterotomy to remove the ileal bezoar.Clinical discussionIntestinal obstruction is considered to be the most common complication of this entity; other possible complications include gastric ulcer, gastritis, and gastric perforation. Due to limitations of endoscopy and barium enema in the diagnosis of bezoar, Abdominal CT-scan is considered to be the gold standard in the diagnosis. The management of phytobezoar can be either conservative or surgical, depends on the lesion size and location.ConclusionAlthough intestinal obstruction secondary to bezoar is rare, multiple levels of gastrointestinal obstruction should raise the suspicion of bezoar.

Gastropleural Fistula in a Child with Acute Lymphoblastic Leukemia Due to Perforated Gastric Ulcer.

Gastropleural fistula (GPF) is a pathological communication between stomach and pleural cavity. GPF is described rarely in adults following bariatric surgery, iatrogenic perforations, complicated empyema thoracis, penetrating chest trauma, perforated malignant gastric ulcers, and invasive tumors. GPF in children is extremely rare. The authors describe a female child with leukemia, who presented with left-sided pneumonia and chylothorax. After a delay of around 3 wk she was diagnosed with GPF, which was due to a perforated gastric ulcer induced by high-dose steroids which she was receiving as chemotherapy. She was managed with repair of GPF and had a favorable outcome.

Outcomes of Nonoperative Treatment for Gastroduodenal Ulcer Perforation: a Nationwide Study of 14,918 Inpatients in Japan

BackgroundGastroduodenal ulcer perforation is a common abdominal emergency that may be curable without surgical repair in non-elderly patients with localized and stable symptoms. However, the outcomes of nonoperative approaches have rarely been described. MethodsUsing a Japanese national inpatient database, we identified 14,918 patients with gastroduodenal ulcer perforation who were hospitalized and received nonoperative treatment from July 2010 to March 2017. We categorized these patients into three groups according to age: 18 to 64 years (young group, n=8407), 65 to 74 years (old group, n=2616), and ≥75 years (old-old group, n=3895). We investigated the characteristics, treatments, and outcomes in each group. ResultsMost of the patients were men (71%), and the median patient age was 62 years (interquartile range, 47–75 years). The old and old-old groups had more comorbidities than the young group. Whereas most patients were administered proton pump inhibitors and various antibiotics (96% and 90%, respectively), only 58% of patients underwent gastric tube placement. Surgical repair >3 days after admission was performed in 7.1% of all patients (6.3% vs. 7.9% vs. 5.5%, P<0.001). The old and old-old groups showed higher mortality (1.4% vs. 8.3% vs. 18%, P<0.001) and morbidity (6.6% vs. 15% vs. 17%, P<0.001) than the young group. The median length of stay was almost 2 weeks (13 vs. 17 vs. 20 days, P<0.001). DiscussionUnlike previous studies, many patients aged >65 years received nonoperative treatment in this nationwide cohort. Our findings provide useful information for clinicians and patients hospitalized for gastric ulcer perforation.

Management of perforated large/giant peptic ulcers: a comparative prospective study between omental plug, duodenal exclusion, and jejunal serosal patch

Background Large/giant peptic ulcer (duodenal ulcer and benign gastric ulcer) perforation is a serious life-threatening surgical emergency, with high morbidity and mortality rates. Despite that, no single surgical approach has yet been shown to be superior to others. Patients and methods This is a prospective randomized study comparing the efficacy of omental plugging, duodenal exclusion, and jejunal serosal patch as different alternating operative techniques in managing such a problem. Results Thirty patients with large/giant peptic perforation more than 2 cm in diameter were included over a period of 24 months. Patients were divided into three groups (A, B, and C) according to surgical approach applied. Males/females were 27/3, average age was 45–73 years old, and mean operative time was 75±28.4 min. Biliary leak rates were 3.3, 10, and 6.6% in group A (omental plug), group B (jejunal serosal patch), and group C (duodenal exclusion and gastrojejunostomy), respectively, with P value of 0.199. Conclusion The management of large/giant peptic (duodenal ulcer and gastric ulcer) perforations is difficult and presents a great challenge to surgeons. Duodenal stump leaks can carry high incidence of morbidity and mortality. Multiple surgical modalities are available to deal with such surgical problems.

Complicated Ventral Hernia: A Perquisite for Perforated Peptic Ulcer—Unusual Clinical Scenario

Introduction Peptic ulcer usually presents to the emergency in the form of an acute abdomen, which is usually diagnosed easily either clinically or radiologically. Although its incidence has decreased with the introduction on proton pump inhibitors it is still one of the most common emergencies encountered by a surgeon. Case Presentation A 60-year-old woman complained of epigastric swelling for 6 months which gradually increased and became irreducible over the last 2 months. The patient also complained of pain associated with vomiting. Radiological investigations revealed a epigastric hernia with omentum and stomach as content along with fluid collection in the right perihepatic region, with tiny air foci. The patient was explored for the same. Discussion Perforated peptic ulcer is a serious complication and carries high risk of morbidity and mortality. Early diagnosis with immediate resuscitation and surgical intervention is essential to improve outcomes. This is a rare case of perforated gastric ulcer which was masked under the complicated ventral hernia.

Laparoscopic Repair of Perforated Gastric Ulcer by Forming a “Covered Perforation”

Performing video endoscopic operations on patients with emergency surgical pathology in order to increase the efficiency and reduce the duration of surgical intervention, as well as to prevent postoperative complications, stimulates the continuous development and implementation of new minimally invasive technologies in emergency surgery. The aim of the study was to develop a new method for laparoscopic suturing of a perforated gastric ulcer (PGU) with the formation of a “covered perforation.” The proposed method uses a fold-duplicator from the anterior wall of the stomach to close the perforation of the stomach wall, thus expanding the possibilities of using minimally invasive technologies for PGU.

A CROSS-SECTIONAL STUDY TO PREVALENCE OF HELICOBACTER PYLORI IN PEPTIC ULCER PERFORATION AT DMCH, LAHERIASARAI, BIHAR

Background: Helicobacter pylori have an important role in the pathogenesis of peptic ulcer disease. The aim of the present study was to observe the prevalence of H. pylori in peptic ulcer perforation cases and the rationale of H. pylori eradication therapy post operatively and to investigate factors associated with peptic ulcer. Methods: This cross-sectional study was conducted at the Upgraded Department of Surgery, Darbhanga Medical College &amp; Hospital, Laheriasarai, Bihar. A total of 113 patients were participated in the study after meeting inclusion criteria. After getting written consent from the patients with perforated peptic ulcer, resuscitation and laparotomy was performed in the emergency department. H. pylori infection was conrmed by histopathological examination by Giemsa staining. Based on the histopathological report, the prevalence of H. pylori infection in the patients was assessed and was given appropriate H. pylori eradication regimen. Results: The mean age of presentation of the patients was 52.81±14.5 years. Male to female ratio was 4.14:1. Out of 113 cases, 67 cases (59.3%) had duodenal ulcer perforation while 46 cases (40.7%) had gastric ulcer perforation. Of them 53(46.9%) cases were positive H. pylori positive. No signicant association was found between the incidence of H. pylori infection in peptic ulcers with smoking, hypertension, diet intake, NSAIDS intake. In our study association between H. pylori and diabetes mellitus (p=0.02) found to be signicant which can be further investigated. Conclusion: According to our study the prevalence of H. pylori infection in perforated peptic ulcer disease is 47% which must be considered as signicant. Hence all the patients undergoing laparotomy for peptic ulcer perforation should be investigated for H. pylori infection and if positive we must start the anti H. pylori regimen for them, which is more cost effective.

Modern aspects of the complex treatment of perforated gastric and duodenal ulcer

To study the effectiveness of pharmacotherapy for perforated gastric ulcer in a surgical hospital. A retrospective analysis of the treatment of 693 patients with perforated gastric and duodenal ulcers was carried out. Laparoscopic and open surgeries were performed. Statistical analysis was performed using the Statistica and MS Excel software packages. Student t-test was applied for independent samples and Fisher's F-test was calculated. Combined therapy included surgical treatment (suturing of the ulcer as a rule) and medication with proton pump inhibitors, antibacterial drugs. Over the past 5 years, postoperative quality of life has been significantly improved in patients with perforated ulcers. Stomach resection and vagotomy for perforated ulcers will become historical in the near future. Laparoscopic and open procedures ensure similar periods of ulcer closure. Currently, successful treatment of perforated gastric and duodenal ulcers requires an integrated approach at all levels of specialized care and is impossible without modern pharmacotherapy.

Multiorgan air embolism as a complication of ruptured gastric ulcer

Introduction: The gas in the vessels of the portal system and arterial vessels is a very disturbing symptom and life-threatening condition. Aim: The aim of this study is to present a case of gas in the left ventricle (LV), ascending aorta (Ao), superior mesenteric vein (SMV) and hepatic portal vein (HPV) as a complication of gastric ulcer perforation (GUP). Case study: A 78-year-old male patient, who had undergone a laparotomy due to gas in the HPV, SMV, Ao, and both chambers of the heart with concomitant GUP and critical pyloric stenosis. Laparotomy revealed perforation of the gastric wall with limited wall necrosis and critical pyloric stenosis. The patient died on postoperative day 1 due to multiple organ failure. Results and discussion: The presence of gas in HPV (HPVG) and systemic circulation is a rare pathological condition associated with various abdominal diseases. GUP with a gas in the HPV, MV and Ao is very rare. While the mechanism of gas entry into the portal veins of the portal system is better understood, the paths of gas entry into the arterial vessels are still not fully understood and their descriptions are casuistic. Conclusions: The treatment of patients with air in the HPV and systemic vessels is extremely difficult and has a very high risk of failure.

A CLINICAL CASE OF COEXISTENT PARASITIC LIVER AND GASTRIC LESIONS CAUSED BY CLONORCHIASIS

Clonorchiasis is a parasitic disease caused by Clonorchis sinensis. Parasite colonies can develop not only in the bile and pancreatic ducts but also in the gastric wall. This is confirmed by the described clinical case of perforated gastric ulcer, the morphological study of which revealed parasite colonies in the wall of the organ.