ĐIỀU TRỊ PHẪU THUẬT SỐC MẤT MÁU DO GIST DII-DIII TÁ TRÀNG TRÊN BỆNH NHÂN NHÓM MÁU RH ÂM

Abstract

Study aim: Restrospective study aim at evaluate the clinical and paraclinic feature of blood loss  shock patient due to  DII-DIII duodenal GIST whose Rhesus negative group and the emergency surgical result. Medical record: The man, aged of 60 year old, emergency hospitalization  due to menela in 3 days. Upon admission he had menela and hemachezia. Digital examination: bright blood. Pulse rate 120-130 beats/m, blood pressure 80-90 mmhg. CTScan revealed tumor 3-4 cm in diameter, hypervascular. Biology examination: Gloule 2,13 T/l. Hemoglobin: 6,6 g/L, Hematocrite: 18,7%. while blood cell count:15,72 G/l. Glumerulemie 257 G/L. Blood transfusion (Preopertion) 2 unit (Rh negative). Emergency operation. Intraoperation lesion: Tumor 3 cm-4cm in diameter  located at  DII-DIII junction. The duodenal DIII-DIV, large and small intestine filled up with bright blood. Surgical procedure: duodenal DII-DIII (below ampulllary) resection with end to end annastomosis (2 layers), antrectomy with 16 F tube duodenostomy for compresion. Post operation was simple. Discharged 14 day postoperation. Imunohistochemistry: GIST /1 mitoses /5mm2. Conclusion: Duodenal segmentectomy for bleeding  duodenal junction DII-DIII GIST in  emergency operation showed safe surgical procedure with low mortality and morbility in comparation to duodenopancreatic (PD) resection espcally in blood loss shock patient. PD procedure  should be indicated in case d GIST located in papilla of Vater or more than 5 cm  in diameter located in DII. In case of massive bleeding and blood loss shock, intervention radiology and selective embolization should be consisdered as alternative solution.