Flakes

In the surgical department of the hospital on the third day of hospital stay of the neurological department was transferred to the patient, 46 years, first mooted two kissing duodenal ulcers complicated by active hemorrhage, severe anemia, a suspected perforated ulcer and peritonitis. From history we know that the patient before the hospital itself uncontrollably orally accepted diclofenac what he was silent when collecting medical history neurologist on admission to hospital for chronic discogenic sciatica with radicular syndrome, pain, and muscular-tonic syndromes.

Of the comorbidities noteworthy: Coronary heart disease, angina brand viagra online functional class II, heart failure II B stage II obesity degree. The patient received comprehensive treatment under the "guise" antiulcer drugs. The grounds for transfer to the surgical department was the sudden deterioration of health against the background of hemodynamic parameters and the appearance of tarry stool for 3 days of treatment; urgently implemented fibrogastroduodenoscopy which identified two "kissing" duodenal ulcers (LDPK) held the bleeding from an ulcer back wall (Forrest II bc), indirect signs of perforation of ulcers on the anterior wall LDPK. State is regarded as serious. The clinical picture of peritonitis worn out, the pain is moderately expressed, the usual perforation of a hollow organ muscle tension in the anterior abdominal wall and the positive symptom Shchetkina-Blumberg is not revealed, was absent and X-ray picture of the presence of free gas in the abdomen, even after fibrogastroduodenoscopy. Because of severe somatic diseases, anemia, as well as the absence of ulcer history and erased the clinical picture were the indications for diagnostic laparoscopy. Intraoperatively revealed an acute ulcer perforation, the anterior-superior wall LDPK, diffuse serous-fibrinous peritonitis in a reactive phase.

Stood out unnaturally large amount of serous effusion character with a small admixture of gastric contents and flakes of fibrin in a short period of perforations (about 2.5 liters) with mild clinical picture of peritonitis. Under further revision after drainage of the abdominal cavity revealed that the liver is cirrhotic change. Appear before the surgery the patient had a small ascites due to portal hypertension in cirrhosis of the liver, after perforation of gastric contents or exudates to dilute ascites, which led to the clinical picture erased. This was confirmed in the postoperative period, prolonged discharge of drainage on a transparent light fluid with properties more similar to the transudate, leakage through the seams of his. Operation of suturing the perforation was completed Z-shaped suture intrakorporalnym with fixing the line of suture strands of the greater omentum, sanitation and drainage of the abdominal cavity in the standard places the two drainages. The postoperative period was smooth, drains removed at 5-6 days. Peristalsis has listened to-day operations, self-discharge of gases on the first day, the chair on day 3. The control fibrogastroduodenoscopy been little postoperative deformity LDPK.

Conclusion.

This technique (LU ulcer) has been successfully used by us and in young patients. The key to successful treatment, above all, is an early activation of patients after low-impact operation. Thus, the use of laparoscopic suturing of acute perforated gastroduodenal ulcers is warranted in patients with concomitant somatic diseases, as well as younger patients. The application of this technique requires equipping surgical hospitals garrison hospital endovideohirurgicheskoy apparatus with a full set of tools and consumables, active learning the basics of laparoscopic surgical emergency surgery. "Wipe" the same on the "big" endovideosurgery, unfortunately we can not lack in the arsenal of good equipment (coagulators) for hemostasis, and suturing devices.

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