Abstract
A 63-year-old man was admitted with a 1-year history of upper abdominal pain. Abdominal CT showed a thickened wall of the stomach with inflammatory changes extending from the antrum to the descending part of duodenum and abnormalities around the duodenal bulb suggestive of free fluid and air. Laparotomy was performed on suspicion of perforated duodenal bulb ulcer, and a perforated duodenal bulb ulcer was confirmed in the duodenal bulb, in the superior to posterior wall. T-tube duodenostomy and omental patch repair were performed. From postoperative day (POD) 1 to POD12, a somatostatin analogue was injected with a proton-pump inhibitor, which led to a rapid decrease in the amount of discharge from the omental patch drain and T-tube. On POD 13, duodenography showed no leakage from the duodenal bulb, and the patient went on a diet again was restarted on oral feeds. On POD 26, after the fistula formation was accomplished, the T-tube was removed inward from the stomach via the mouth. On POD 39, the patient was discharged. Thus, perforated duodenal bulb ulcer was treated effectively with a somatostatin analogue, proton-pump inhibitor, T-tube duodenostomy, and omental patch repair, without any postoperative complications.
