NDLI: Perforation of anastomotic peptic ulcer following pancreaticoduodenectomy: a report of three cases

Content Provider	Springer Nature : BioMed Central
Author	Shioi, Ikuma Yokoyama, Naoyuki Hirai, Motoharu Komatsu, Masaru Kubota, Akira Aoki, Makoto Sato, Daisuke Otani, Tetsuya
Abstract	Background Perforation of a marginal peptic ulcer after pancreaticoduodenectomy (PD) can lead to severe conditions, although its clinical features have not been well reported. In this article, we present three cases of marginal peptic ulcer perforation after PD that we experienced in our institute and attempt to clarify its appropriate treatment and prevention. Case presentation Marginal ulcer perforation confirmed with computed tomography and/or surgical exploration occurred in 3 (1.8%) of 163 consecutive patients who underwent PD (including 160 patients who underwent a total or subtotal stomach-preserving procedure) at our institution. The three patients (one man and two women) had a median age of 77 (65–79) years. Two of these patients had a medical history of duodenal peptic ulcer. All three patients had biliary neoplasms. Two of the patients underwent subtotal stomach-preserving PD with antro-jejunal anastomosis, and the other patient underwent pylorus-preserving PD with duodenal jejunostomy. The perforation occurred with a sudden and severe onset of abdominal pain 34, 94, and 1204 days, respectively, after the PDs. At the time of the perforation, all of the patients had been withdrawn from postoperative prophylactic antipeptic ulcer agents, with the cessation periods ranging from 12 to 1008 days. In addition, all the patients were in fasting conditions for 1 to 13 days just before the perforation. Surgical treatment with direct suturing of the perforated ulcer was performed for two patients, while conservative therapy was performed for one patient. Their primary treatment courses were satisfactory. Chronic antisecretory agent therapy was prescribed for 562, 271, and 2370 days, respectively, from marginal ulcer perforation, and no ulcer recurrence was noted in any of the patients. Conclusions Lack of antisecretory therapy and fasting were considered an essential cause of marginal peptic ulcer perforation after PD. In addition, unlike the native duodenum, the jejunal limb used for reconstruction to a preserved stomach may be at increased risk of ulceration. Chronic permanent administration of antisecretory agents and fasting avoidance are desirable for patients who have undergone stomach-preserving PD to prevent marginal ulcer perforation.
Related Links	https://bmcsurg.biomedcentral.com/counter/pdf/10.1186/s12893-020-00743-6.pdf
Ending Page	5
Page Count	5
Starting Page	1
File Format	HTM / HTML
ISSN	14712482
DOI	10.1186/s12893-020-00743-6
Journal	BMC Surgery
Issue Number	1
Volume Number	20
Language	English
Publisher	BioMed Central
Publisher Date	2020-04-19
Access Restriction	Open
Subject Keyword	Surgery Internal Medicine Peptic ulcer Gastroduodenal ulcer Intestinal perforation Gastric acid Pancreatic juice Pancreaticoduodenectomy Postoperative complication
Content Type	Text
Resource Type	Case study
Subject	Surgery
Journal Impact Factor	1.6/2023
5-Year Journal Impact Factor	1.9/2023

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