title: Triple-ostomy: management of perforations to the second part of the duodenum in patients unfit for definitive surgery.
abstract: Peptic ulcers in the second part of the duodenum are a rare occurrence and present challenging management. Conventional surgical operations are associated with life threatening complications. We describe a case of a perforated duodenal ulcer in a medically unstable patient who was deemed  unfit for lengthy definitive surgery. An emergency laparotomy and 'triple-ostomy' was performed. We recommend this procedure as an alternative for the emergency repair of D2 ulcers, especially in patients with multiple co-morbidities.
authors: Department of General Surgery, Lincoln County Hospital, Lincoln, UK. phil_herrod@hotmail.co.uk
authors: P J J
authors: PJ
authors: Herrod
authors: D
authors: D
authors: Kamali
authors: S C B
authors: SC
authors: Pillai
mesh_terms: D004385:Duodenostomy / Q000379:methods; D004766:Enterostomy / Q000379:methods*; D005774:Gastrostomy / Q000379:methods; D006801:Humans; D007582:Jejunostomy / Q000379:methods; D008297:Male; D008875:Middle Aged; D010439:Peptic Ulcer Perforation / Q000601:surgery*; D011027:Pneumoperitoneum / Q000209:etiology; D014057:Tomography, X-Ray Computed