title: Gastroduodeno-plasty performed by distal gastric transection.- A new technique for large duodenal defect closure.
abstract: BACKGROUND
  Duodenal ulcer lesions can represent a surgical challenge, especially if the duodenal wall is chronically inflamed, the defect exceeds a diameter of 3 cm and the ulceration is located in the second part of the duodenum.
  
  
  METHODS
  We present the case of a 70-year-old male, who suffered from a 3 x 4 cm duodenal defect caused by duodenal pressure necrosis due to a 12.5 x 5.5 x 5 cm gallstone. Additionally, this stone caused intestinal obstruction (Bouveret's syndrome) and bleeding with signs of shock. Besides the gallstone extraction, the common bile duct was drained by a T-tube and the duodenal defect closure was performed by a gastroduodeno-plasty and Bilroth II gastroenterostomy. The postoperative phase was uneventful. The reconstructed duodenum was endoscopically accessible and showed no pathological findings on follow-up.
  
  
  CONCLUSIONS
  The reconstruction of a large defect (> 3 cm) of the second part of the duodenum is safely feasible by a gastroduodeno-plasty. The critical gastroduodenal anastomosis can be protected by duodenal decompression, achieved by placing a T-tube in the common bile duct.
authors.affiliation: Department of General and Visceral Surgery, Klinikum-Vest, Knappschaftskrankenhaus, Recklinghausen, Germany. utech@uni-muenster.de.
authors.forename: Martin
authors.initials: M
authors.lastname: Büsing
authors.forename: Hassan
authors.initials: H
authors.lastname: Shaheen
authors.forename: Raute
authors.initials: R
authors.lastname: Riege
authors.forename: Markus
authors.initials: M
authors.lastname: Utech