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Open Access Case report

Gastroduodeno-plasty performed by distal gastric transection.- A new technique for large duodenal defect closure

Martin Büsing, Hassan Shaheen, Raute Riege and Markus Utech*

Author Affiliations

Department of General and Visceral Surgery, Klinikum-Vest, Knappschaftskrankenhaus, Recklinghausen, Germany

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Annals of Surgical Innovation and Research 2012, 6:6  doi:10.1186/1750-1164-6-6

Published: 8 August 2012

Abstract

Introduction

Duodenal ulcer lesions can represent a surgical challenge, especially if the duodenal wall is chronically inflamed, the defect exceeds a diameter of 3 cm and the ulceration is located in the second part of the duodenum.

Patient and method

We present the case of a 70-year-old male, who suffered from a 3 x 4 cm duodenal defect caused by duodenal pressure necrosis due to a 12.5 x 5.5 x 5 cm gallstone. Additionally, this stone caused intestinal obstruction (Bouveret’s syndrome) and bleeding with signs of shock. Besides the gallstone extraction, the common bile duct was drained by a T-tube and the duodenal defect closure was performed by a gastroduodeno-plasty and Bilroth II gastroenterostomy. The postoperative phase was uneventful. The reconstructed duodenum was endoscopically accessible and showed no pathological findings on follow-up.

Conclusion

The reconstruction of a large defect (> 3 cm) of the second part of the duodenum is safely feasible by a gastroduodeno-plasty. The critical gastroduodenal anastomosis can be protected by duodenal decompression, achieved by placing a T-tube in the common bile duct.

Keywords:
Duodenal defect; Bouveret’s syndrome; Gastroduodeno-plasty