Utilisation of the falciform ligament pedicle flap as an alternative approach for the repair of a perforated gastric ulcer.
An 83-year-old woman presented to the emergency department with sudden onset of severe abdominal pain. She had a background of ulcerative colitis managed surgically at the age of 18 years with panproctocolectomy and permanent ileostomy. On admission, clinical assessment suggested a visceral perforation and an urgent CT scan demonstrated a perforated prepyloric ulcer. Emergency laparotomy was performed and confirmed a 3 cm perforated pre-pyloric ulcer. Repair of the defect was challenging due to the absence of omental fat to patch the perforation. A modification to the standard technique was therefore performed: the falciform ligament was mobilised and its free end used as a patch to repair the defect. The patient made a good postoperative recovery. This case report highlights an alternative operative technique for the treatment of perforated gastric/duodenal ulcers in patients who lack omentum, or when omentum cannot be used to cover perforated gastroduodenal ulcers.
Department of General Surgery, Queen Elizabeth Queen Mother Hospital, Margate, UK.|Ain Shams University, Cairo, Egypt.
Mohamed
M
Boshnaq
Department of General Surgery, Queen Elizabeth Queen Mother Hospital, Margate, UK.
Amit
A
Thakrar
Department of General Surgery, Queen Elizabeth Queen Mother Hospital, Margate, UK.
Iana
I
Martini
Department of General Surgery, Queen Elizabeth Queen Mother Hospital, Margate, UK.
Samer
S
Doughan
D000369:Aged, 80 and over; D013505:Digestive System Surgical Procedures; D005260:Female; D006801:Humans; D008022:Ligaments / Q000601:surgery*; D008099:Liver; D009852:Omentum; D010439:Peptic Ulcer Perforation / Q000601:surgery*; D013276:Stomach Ulcer / Q000601:surgery*; D013524:Surgical Flaps