2019 Volume 39 Issue 7 Pages 1303-1305
A 67-year-old man with the chief complaint of right-sided abdominal pain was diagnosed as having duodenal perforation and treated by emergency surgery; the semicircular perforation detected in the duodenal bulb was repaired by simple closure. On postoperative day 4, intestinal fluid drainage was observed via the drain and the patient was diagnosed as having panperitonitis, necessitating another emergency surgery. Intraoperative examination at the reoperation revealed complete failure of the suture closure. Because of the severe contamination around the perforated area, we considered that re-suturing would be dangerous, and created a duodenal diverticulum. Superior pancreaticoduodenal artery hemorrhage occurred on post-reoperation day 6, which was controlled by an emergency interventional radiologic procedure. Drain management took time, and the patient was discharged on postoperative day 78. With the widespread use of proton pump inhibitors, gastroduodenal ulcer perforations are currently treated by suture closure of the perforation and coverage by the omentum; however, this technique alone may not always yield a good prognosis. In this patient, reoperation to create a duodenal diverticulum was effective for suture failure after repair of duodenal ulcer perforation.
