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首页> 外文期刊>BMC Surgery >Giant duodenal ulcers after neurosurgery for brainstem tumors that required reoperation for gastric disconnection: a report of two cases
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Giant duodenal ulcers after neurosurgery for brainstem tumors that required reoperation for gastric disconnection: a report of two cases

机译：脑干肿瘤神经外科手术后十二指肠大溃疡，需要再次手术以断开胃壁：两例报道

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Background Despite the efficacy of pharmacotherapy for gastrointestinal ulcers, severe cases of bleeding or perforation due to gastrointestinal ulcers still occur. Giant duodenal ulcer perforation is an uncommon but difficult-to-manage pathology with a high mortality rate. We report two cases of giant duodenal ulcer perforation after neurosurgery for brainstem tumors that needed reoperation for gastric disconnection because of postoperative leakage and bleeding. Case presentation Both cases had undergone neurosurgery for brainstem tumors, and the patients were in a shock state for several days with peritonitis due to giant duodenal perforation. In Case 1, antrectomy with Billroth II reconstruction was performed. However, reoperation for gastric disconnection was needed because of major leakage of gastrojejunostomy and jejunojejunostomy. In Case 2, an omental patch, cholecystectomy, and insertion of a bile drainage tube from the cystic duct were performed for the giant duodenal ulcer, but leakage and bleeding from the ulcer edge required reoperation for gastric disconnection. Conclusions Brainstem tumors in these cases might have been related to duodenal ulcer perforation with late diagnosis that progressed to severe sepsis. For giant duodenal ulcer perforation with poor general condition, simple closure including omental patch or antrectomy with reconstruction is hazardous. Antrectomy with gastric disconnection, meaning gastrostomy, duodenostomy, feeding jejunostomy and cholecystectomy, is recommended.
机译：背景技术尽管药物疗法对胃肠道溃疡有效，但仍会发生严重的因胃肠道溃疡引起的出血或穿孔的病例。十二指肠溃疡大穿孔是一种罕见但难治的病理，死亡率很高。我们报告了两例脑干肿瘤神经外科手术后巨大十二指肠溃疡穿孔的病例，由于术后渗漏和出血，需要再次手术以断开胃壁。病例介绍这两例患者均接受过神经外科手术治疗脑干肿瘤，由于巨大的十二指肠穿孔，患者因腹膜炎处于休克状态数日。在案例1中，使用Billroth II重建术进行了肛门切除术。然而，由于胃空肠吻合术和空肠空肠吻合术的大量渗漏，需要再次手术以断开胃。在病例2中，对巨大的十二指肠溃疡行网膜修补，胆囊切除术和从胆囊管插入胆汁引流管，但由于溃疡边缘的渗漏和出血，需要重新手术以断开胃。结论这些病例的脑干肿瘤可能与十二指肠溃疡穿孔有关，诊断较晚，发展为严重败血症。对于一般状况较差的巨大十二指肠溃疡穿孔，包括网膜或修补术在内的简单闭合再造术是危险的。推荐胃切除术，即胃造口术，十二指肠造口术，喂养空肠造口术和胆囊切除术。

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