2022 Volume 42 Issue 4 Pages 557-560
An 87-year-old woman with a hemorrhagic duodenal ulcer was transferred to our hospital because of persistent hemorrhage and difficulty in hemostasis. Upper gastrointestinal endoscopy revealed a huge ulcerative lesion with arterial hemorrhage on the posterior wall of the duodenal bulb. Endoscopic hemostasis was attempted, but the massive bleeding led to hemorrhagic shock, and emergency laparotomy was performed. Intraoperative observation revealed that the duodenal ulcer had penetrated the head of the pancreas and was firmly adherent to it. Pancreaticoduodenectomy was also considered as a surgical procedure, but considering the advanced age of the patient and his general condition in the presence of hemorrhagic shock and coagulopathy, we performed distal gastrectomy with the ulcer floor left on the pancreatic side. The postoperative course was uneventful, with no development of a postoperative pancreatic fistula, and the patient was transferred to the previous doctor on the 24th postoperative day. Hemorrhagic duodenal ulcer penetrating into the pancreas requires prompt attention and careful treatment selection.
