ĐIỀU TRỊ PHẪU THUẬT XUẤT HUYẾT TIÊU HÓA NẶNG, SỐC MẤT MÁU DO LOÉT DII TÁ TRÀNG DƯỚI BÓNG VATER HIẾM GẶP

Abstract

Study aim: 1. Case report of clinic and para clinic feature of  massive bleeding DII Duodenal ulcer and blood loss shock in association with risk factors as liver cirrhosis (Alcohol abuse), diabetes mellitus, hypertension. 2. The result of emmergency surgical management and post operative treatment of rebeeding. Patient and method: +Case report. +Retrospective study. Result: Man, 60 years old, medical history: Liver cirrhosis (Alcohol abuse), diabetes mellitus, hypertension. Admission at urgent department due to hematemesis and melaena. Systolic blood presure < 90/60 mmhg, pulse 120-140 beats/min. +Clinic featrure: Hematemesis, melena with masive volume,nasogastric tube with red blood,. +Laboratory examination: (on admission) Globule 3,1 G/l,Hemoglobule 9,4 g/L.Hematocrite: 0,27 L/L. ++Glumerulemie: 128 G/L: Bilirubilemie  8,1 mmol/L; Albumin 32,9 g/L; ure 3,5 mmol/L; creatinin mmol/l: 61, glucosemie: 7,24 mmol/L,GOT: 58,1 U/l;  GPT: 41,5 U/l. ++Blood transfusion: 6 U (250 ml/1U,preoperarion). ++Post blood transfusion: Globul: 2,55 G/l; Hb: 7,6 g/L.Hematocrit: 0,217 L/L.Glumerulemie 65.G/L. +Endoscopy finding: The clot s and red blood in the lumen of  stomach,not found ulcer or vessel visible,clots and blood intra lumen of DII Duodenum and surrounding  papillary orifice ,not found ulcer or lesion. + Urgent CTscan multislide: (aim at finding bleeding artery): There was active bleeding spot  distal to  papilla, intra luminal DII duodenum, eroded to encephalic pancreatic artery, about 6mm in diameter. + Emmergency operation: + Operation performed: Longitudial incision of DII Duodenum, bleeding ulcer located distal to the papilla, suture of bleeding ulcer distal to papillary orifice 1,2 cm in diameter (X suture, PDS 3.0),2/3 gastrectomy, duodenostomy with 16 FR tube,gastrojejunostomy (Finsterer). +Rebleeding postoperation: 8 mg Nexium/h give (intrvenous transusion). Blood Transfusion 2 Unit (250 ml/U). Stop bleeding and discharge home. Hospital stay: 21 days. Concusion: We concluded that this was complicated emmergency operation for D2 duodenal bleeding ulcer (location of bleeding ulcer below papillary orifice), massive  blood loss,hypovolemic shock  in association with risk factors as Liver cirrhosis (Alcohol abuse), diabetes mellitus, hypertension. The surgical procedure including  hemostasis suture of D2 duodenal bleeding ulcer, 2/3 gastrectomy with duodenostomy of compresion, gastrojejunostomy was satisfactory with good result. Minor rebleeding post operation was treated by intravenous 8mmg nexium/h  obtained good  hemostasis. None of complication related to operation.