Technique to manage persistent leak from a prepyloric ulcer where a distal gastrectomy is not appropriate.
Perforated peptic ulcer disease remains a relatively frequent emergency surgery presentation. Persistent leak is the most common indication for return to theatre. We present a technique to manage patients in whom a more substantial resection is not possible. A 45-year-old woman underwent initial laparoscopic primary closure of a non-malignant perforated gastric ulcer. This subsequently leaked on return to the UK and had a further graham patch formed via a laparotomy. Unfortunately, the patch repair leaked and at reoperation a wedge excision or distal gastrectomy was not possible given the friability of the tissues and instability of the patient, a transgastric drain and perigastric drain were therefore placed. This created a controlled fistula, which was managed eventually as an outpatient. Transgastric drains in the context of the persistent perforated gastric ulcer leak are a safe way to manage the unstable patient with poor tissues where more substantial surgeries such as a distal gastrectomy are not possible.
Peninsula Deanery, Torbay Hospital, South Devon Healthcare Trust, Torquay, UK kirk_bowling@hotmail.com.
Kirk
K
Bowling
Peninsula Deanery, Torbay Hospital, South Devon Healthcare Trust, Torquay, UK.
Alison
A
Balcombe
Peninsula Deanery, Torbay Hospital, South Devon Healthcare Trust, Torquay, UK.
Jaideep
J
Rait
Peninsula Deanery, Torbay Hospital, South Devon Healthcare Trust, Torquay, UK.
Stuart
S
Andrews