[Unusual indication for 2/3 gastroduodenopancreatectomy in ulcer of the papilla, acute pancreatitis and massive ascites].
A 32-year-old worker, an alcoholic with a history of duodenal ulcer for 2 years, was admitted because of weight loss, severe pain in the upper abdomen, and ascites. Serum lipase was 1200 mU. X-ray showed a possible postbulbar ulcer. Laparotomy was performed, and 10 1 ascitic fluid were evacuated, the latter caused by a peripancreatic callosity compressing the portal vein.


RESULTS
multiple necrotic areas in the pancreas; sequestrum cavity in the head of the pancreas connected with a callous ulcer at the duodenal papilla (histology: no malignancy). Two-thirds gastric resection, subtotal duodenopancreatectomy, extirpation of the gallbladder and common bile duct, splenectomy, gastroenteroanastomosis, and antecolic hepatojejunostomy were performed. After a transitory cerebrovascular incident, the patient was discharged on the 34th postoperative day. The patient has gained 11 kg, and works in the construction business. The pathogene development, frequency of complications, and therapy of postbulbar ulcer are described.
D000208:Acute Disease; D000328:Adult; D001201:Ascites / Q000601:surgery*; D004381:Duodenal Ulcer / Q000601:surgery*; D004386:Duodenum / Q000601:surgery; D005743:Gastrectomy; D006801:Humans; D008297:Male; D010180:Pancreatectomy; D010195:Pancreatitis / Q000601:surgery*
Seltene Indikation zur 2/3 Gastroduodenopankreatektomie bei Papillenulcus, akuter Pankreatitis und massivem Ascites