2023 Volume 43 Issue 7 Pages 1071-1074
An 84-year-old man with a medical history of hypertension and duodenal ulcers who was receiving treatment with an H2-blocker was transferred to our hospital because of tarry stools and impaired consciousness. Abdominal computed tomography showed free air in both the abdominal cavity and retroperitoneal space. Emergent laparotomy showed a perforated lesion measuring 4 × 2 cm in the descending part of the duodenum and a stenotic scar in the oral aspect of the lesion. Simple closure of the perforated lesion was not possible. A transmural duodenotomy was performed from the ulcer to the scar, and side-to-side duodenojejunostomy was performed in a Roux-en-Y fashion. The postoperative course was complicated by a minor anastomotic leak, but the leak healed with conservative treatment. Side-to-side duodenojejunostomy can be performed regardless of the anastomosis size, making it a useful procedure for huge duodenal ulcers that are difficult to treat by simple closure.
