Laparoscopic suture repair of a perforated gastric ulcer in a severely cirrhotic patient with portal hypertension: first case report.
BACKGROUND
Open digestive surgery in cirrhotic patients is associated with high morbidity and mortality. Laparoscopy in this setting has the potential to reduce postoperative complications. Laparoscopic treatment of a perforated gastric ulcer in a severely cirrhotic patient with portal hypertension is herein described.


METHODS
A 75-year-old woman affected by cirrhosis of the liver (Child class C) and chronic gastric ulcer presented with acute abdominal pain. The diagnosis of perforation was made with plain films of the abdomen and computed tomography. Diagnostic laparoscopy showed intense peritonitis due to a perforated ulcer of the anterior gastric wall, 2 cm proximal to the pylorus. Suture closure and placement of an omental patch were performed laparoscopically.


RESULTS
Postoperative recovery was complicated by a minor leak of the gastric suture, managed by total parenteral nutrition. Closure of the gastric wound was demonstrated by Gastrografin studies on the 10th postoperative day. The patient was discharged on the 16th postoperative day. At 3-months follow-up, the patient is alive and free of gastric disease.
Gentileschi
Paolo
P
Department of Surgery, University of Tor Vergata, Rome, Italy. gentilp@yahoo.com
Rossi
Piero
P
Manzelli
Antonio
A
Lirosi
Francesca
F
Susanna
Francesca
F
Stolfi
Vito Maria
VM
Spina
Claudio
C
Gaspari
Achille L
AL
D000368:Aged; D013505:Digestive System Surgical Procedures / Q000379:methods*; D005260:Female; D006801:Humans; D006975:Hypertension, Portal / Q000209:etiology / Q000601:surgery*; D010535:Laparoscopy / Q000379:methods*; D008103:Liver Cirrhosis / Q000150:complications / Q000601:surgery*; D010439:Peptic Ulcer Perforation / Q000601:surgery*; D013276:Stomach Ulcer / Q000150:complications / Q000601:surgery*; D013536:Suture Techniques; D016896:Treatment Outcome