Repair Of Duodenal Perforation Research Articles

Gastric Outlet Obstruction: A Case Report

Introduction: Gastric outlet obstruction is an obstruction in the pylorus of stomach it is also known as apyloric obstruction. It is a common condition but sometimes accurate cause could not be found in thesecases it can be diagnosed on the basis of signs and symptoms and on diagnostic evaluation i.e endoscopicexamination, barium meal, ultrasonogaphy, computed tomography and chest x-ray.Case Presentation: Here we are mentioninga 50- year’sold male visited our hospital with the complaintsof severe abdominal pain, nausea and vomiting since 2 days, weakness since 5 months, has passed stool 2days ago, weight loss for 2 months. All routine laboratory tests were done in this case and all the resultswere within normal range except decreased hemoglobin level, increase in white blood cells also increasedcreatinine level and decreased albumin level. In Abdominal ultrasonography it was mentioned that severelyedematous mucosa with erosive patches and places, Pyloric canal deformed scope could not be negotiatedacross the pylorus. Barium meal study depicted dilated stomach where greater curvature is below the levelof iliac crest. Finally a client case was diagnosed as a gastric outlet obstruction. Primarily as per priorityBlood transfusion and all conservative treatment was started by surgical team but client was not relievedof obstruction by the medical management. Diagnostic exploratory laparotomy with repair of duodenalperforation with gastrojejunostomy under general anesthesia was done. Vital signs and cardiac monitoringwas done. Maintained intravenous fluid and colour of drainage was observed, propped up position andantibiotic, analgesic, anti emetic given and ryle’s tube aspiration was done 4 hourly also abdominal girth wasalso measured 4 hourly. A positive response to treatment was observed by patient. Patient was dischargedwith full recovery without any postoperative complication.Conclusion: In this study, we mainly focus on expert surgical management and quality nursing care dueto which the patient was discharged without any postoperative complications and satisfaction with fullrecovery

Modified Graham’s repair for peptic ulcer perforation: reassessment study

Background: Peptic perforation is an emergency and requires urgent surgical treatment. Many modalities of treatment are available ranging from conservative treatment to laparoscopic repair. There is no consensus on treatment of perforated pylorodudenal ulcer which can be treated with conservative treatment, simple closure of ulcer, closure of ulcer with free omentum, closure of perforation with use of pedicled omentum, definitive treatment with truncal vagotomy and drainage procedures or parietal cell vagotomy. However best treatment is still to be decided.Methods: This study was conducted in department of surgery 60 patients presenting with peptic perforation in last three years. All patients with duodenal perforation in first part (D1) were included in the study. Pyloric perforations, multiple perforations, traumatic perforations and severe co-morbid condition were excluded from study. A pedicled omentum was used in the repair of duodenal perforation. Immediate and late postoperative complications were recorded. The patients were followed for three months.Results: Out of 60 cases there were 50 male patients and 10 female patients. The majority of male patients were in the middle age group between 35 to 45 years of age and the female patients were of older age group between 40 to 65 years of age. These patients presented with history of acute pain abdomen in the epigastric region. All the patients underwent modified Graham’s patch repair. In postoperative period, two patients had burst abdomen on fourth postoperative day. Biliary fistula formation occurred in 2 patients. Wound infection occurred in 4 patients and the hospital stay was 5 to 9 days. There was no mortality recorded in this series.Conclusions: In summary, the surgery for perforated peptic ulcer should use modified Graham’s repair using pedicled omentum giving excellent results in terms of healing, morbidity and mortality.

Successful treatment of enterocutaneous fistula in a premature newborn by using octreotide

A premature newborn with an enterocutaneous fistula after repair of duodenal perforation is reported to emphasize the therapeutic effect of octreotide in persistent fistula even in a very small infant. Our report showed that use of octreotide was safe even in premature infants with intestinal fistula. Close monitorization of biochemical and blood parameters is needed in patients treated with octreotide.