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THE CLINICAL AND PARACLINICAL FEATURES, RISK FACTORS AND SURGICAL RESULT OF COEXISTENCE OF GASTRIC CANCER AND DUODENAL ULCER
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Abstract
Study aim: Retrospective study aimed at evaluating the clinical and paraclinical features, risk factors and result of surgical management of coexistence of gastric cancer and duodenal ulcer. Result: There were 18 patients, mean age 63,8 year old (47-77), male 83,3%, female 16,7%. History of duodenal ulcer was 55,6%; History of duodenal ulcer perforation was 16,7%; acute pancreatitis 11,1%. Examination: epigastric pain in 55,6%, gastric outlet obstruction in 44,4%, gastrointestinal bleeding in 11,1%. Gastroscopy revealed duodenal ulcer and gastric cancer in 50%; gastric cancer and no ulcer of duodenum in 50%. Intraoperation lesions: Gastric cancer-anterior duodenal ulcer 12/18 (66,7%); Gastric cancer-kissing duodenal ulcer 1/18 (5,5%); Gastric cancer, gastric outlet obstruction due to duodenal ulcer in 4/18 (22,2%). Operation performed: Subtotal gastrectomy, lymphadenectomy, duodenal ulcer resection with duodenostomy in 5/18 (27,7%); Subtotal gastrectomy, lymphadenectomy, duodenal ulcer resection with 2 interrupted layer duodenal stump suture and reinforcement suture into panceatic head in 5/18 (27,7%); Subtotal gastrectomy, lymphadenectomy, duodenal ulcer resection with 2 interrupted layer in 5/18 (27,7%), Subtotal gastrectomy, lymphadenectomy, duodenal ulcer resection with 2 running-interrupted layer in 3/18 (16,7%). Complication: Post operative obstruction in 1 patient, No duodenal stump leakage. Conclusion: The coexistence of gastric cancer and duodenal ulcer is rare in patients whose had duodenal ulcer treatment or history of duodenal ulcer perforation. The Helicobacter pylori infection by different stains or under acid supression therapy for along time may be risk factors for gastric cancer. The surgical management of coexistence of gastric cancer and duodenal ulcer could be technical difficult due to deformation of duodenal stump related to Vater ampullary. Duodenostomy or duodenal stump plasty may be good solution.
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Keywords
gastric cancer, duodenal ulcer, Helicobacter pylori, duodenostomy, duodenal stump plasty
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