ĐIỀU TRỊ PHẪU THUẬT XUẤT HUYẾT TIÊU HÓA NẶNG DO LOÉT TÁ TRÀNG KISSING ULCER THỦNG VÀO ĐỘNG MẠCH VỊ TÁ TRÀNG VÀ LOÉT DẠ DÀY - TÁ TRÀNG

Abstract

Study aims: 1. Evaluation of clinical feature of urgent duodenal bleeding kissing ulcer and gastroduodenal bleeding ulcer. 2. The result of urgent surgical management  of duodenal bleeding kissing ulcer and gastroduodenal bleeding ulcer. Patient and method: +Restro spective study. +Time: 2018-2022. Result: There were 12 patients of  massive duodenal  bleeding kissing ulcer and gastroduodenal bleeding ulcer were observed in K hospital.The mean age was 59,5 (range 49-78 year old),100% was male. + History feature: There were 3 patients had gastroduodenal  perforgation,one had bleeding duodenal ulcer, 3 others patients had colorectal cancer, one patient had esophagealcancer. + Clinical feature: Of them,hematemesis  and melena in 50%,melena in 100%. Gastroduodenalscopy revealed bleeding gastriccancer in 5 patients;bleeding duodenal ulcer in 6 patients, inability to locate  the bleeding lesion due to a large amount of clots in stomach and duodenum lumen but suspected the bleeding lesion in the 2nd duodenum (below papillary orifice) that confirmed by multislide CT Scanner. There were 5 patients had hypovolemic shock due to blood loss and had urgent operation; 4 of the five had  bleeding duodenal kissing ulcer but 2 of them had kissing ulcer  eroded to gastroduodenal artery, one patient of the five had 2 duodenal ulcers but one located below papillaryorifice (the bleeding ulcer). - Surgical management consisted of: 2/3 gastrectomy with duodenal ulcer ablation in 4 patients (with duodenostomy  because of difitculty in closure of duodenal stump  close to papille),5 others patients had suture  of bleeding duodenal ulcer for hemostasis and gastrojejunostomy, 3 others patients had subtotalgastrectomy for bleeding gastriculcer. + Death and complication: + No death per and post operation. + There were 2 rebleeded duodenal ulcer post suture of  duodenal ulcer for hemostasis that had PPI medication. + One had duodenal fistulas that recovered by medical treatment for 2 weeks. Consclusion: + Massive bleeding gastroduodenal ulcer and  duodenal bleeding kissing ulcer was urgent surgical management especally to whom having posterior duodenal ulcer or kissing ulcer eroded to gastroduodenal artery  causing hypovolemic shock with a large amount of blood loss. + There were lots of dificulty in its management due to massive bleeding kissing ulcer that eroded to gastroduodenal artery. It was nessesary  to suture for hemostasis prior to 2/3 gastrectomy with ulcer ablation and duodenostomy. + Suture for hemostasis without ulcer ablation  and  acid secretion zone resection or vagotomy had elevated rebleeded proportion and had no radical ulcer treatment.