title: [Giant duodenal ulcer perforation: a case of innovative repair with an antrum gastric patch].
abstract: BACKGROUND
  the treatment of a perforated giant duodenal ulcer (GUDs) represents a formidable surgical challenge regarding the duodenal wall defect repair in severe peritonitis setting. A high incidence of dehiscence and hospital mortality (15-40%- has been reported with the majority of the techniques). We report a case of GUDs perforation successfully treated with a subtotal gastrectomy and a gastric patch with the remnant antrum, for repairing the duodenal defect.
  
  
  METHODS
  a 63-years-old man with antecedents of peptic ulcer disease presents a large duodenal ulcer perforation with 48 hrs delay and associated with severe peritonitis and a retroperitoneal collection. A subtotal gastrectomy with Billroth II reconstruction and reconstruction of the duodenal defect with a patch of the remnant antrum was carried out. The patient was discharged at 17th postoperative day with good tolerance.
  
  
  CONCLUSIONS
  the duodenal defect repair with a patch of the remant antrum, represents a valid alternative in similar circumstances. To our knowledge, it appears to be the first clinical description of this technique.
authors.affiliation: Departamento de Cirugía General y Digestiva, Clínica Universidad de Navarra, Pamplona, Navarra. fjacien@unav.es
authors.forename: Javier A
authors.initials: JA
authors.lastname: Cienfuegos
authors.forename: Fernando
authors.initials: F
authors.lastname: Rotellar
authors.forename: Víctor
authors.initials: V
authors.lastname: Valentí
authors.forename: Jorge
authors.initials: J
authors.lastname: Arredondo
authors.forename: Jorge
authors.initials: J
authors.lastname: Baixauli
authors.forename: Nicolás
authors.initials: N
authors.lastname: Pedano
authors.forename: Manuel
authors.initials: M
authors.lastname: Bellver
authors.forename: José Luis
authors.initials: JL
authors.lastname: Hernández-Lizoaín
mesh_terms: D013505:Digestive System Surgical Procedures / Q000379:methods*; D004381:Duodenal Ulcer / Q000382:microbiology / Q000473:pathology / Q000601:surgery*; D005743:Gastrectomy; D016481:Helicobacter Infections / Q000150:complications; D016480:Helicobacter pylori; D006801:Humans; D008297:Male; D008875:Middle Aged; D010439:Peptic Ulcer Perforation / Q000473:pathology / Q000601:surgery*; D010538:Peritonitis / Q000209:etiology; D011706:Pyloric Antrum / Q000601:surgery