Combined acute surgical pathology of the hepatopancreatoduodenal zone: gastric resection or stem vagotomy with gastric drainage surgery? A clinical case.

In recent decades, resection interventions for complications of peptic ulcer of the stomach and duodenum have been a backup option for surgical care. Vagotomy with gastric drainage surgery can be performed as a less traumatic intervention in severe comorbid condition. The purpose of this work is to analyze a clinical case of surgical treatment of combined complications of duodenal ulcer occurring against a background of combined abdominal and severe concomitant pathology. The patient underwent stem vagotomy with pyloroplasty according to Finney, cholecystectomy with drainage of the stump of the cystic duct according to   Halsted – Pikovsky. The postoperative period was complicated by suture failure, traumatic bleeding from the duodenum, which was successfully supervised by conservative measures and endoscopic procedures. Minimally invasive endoscopic and surgical technologies should be used to treat life-threatening complications of duodenal ulcer in patients with severe comorbid background. The long-term results of treatment of a patient with a complicated course of peptic ulcer disease, combined surgical and severe concomitant pathology, presented in this clinical case, allow us to confirm the correctness of the choice of organ-preserving surgical tactics.

duodenal ulcer, duodenal stenosis, gastrointestinal bleeding, vagotomy, pyloroplasty, intestinal suture failure, duodenal fistula