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首页> 外文期刊>Updates in Surgery >Bleeding from duodenal ulcer in a patient with bilio-pancreatic diversion
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Bleeding from duodenal ulcer in a patient with bilio-pancreatic diversion

机译：胆汁-胰腺转移患者十二指肠溃疡出血

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摘要

Scopinaro’s bilio-pancreatic diversion is considered as an acceptable malabsorptive surgical approach for the treatment of morbid obesity. We describe a case of acute recurrent gastro-intestinal bleeding in a patient with a previous Scopinaro’s bilio-pancreatic diversion. At the first admission in our department, gastroscopy, colonoscopy, contrast-enhanced computerized tomography and angiography resulted negative for active bleeding. Hypovolemic shock indicated laparotomy and an intraoperative enteroscopy performed through a small enterotomy showed an ulcerative perforation sourced in an ischemic portion of a distended duodenal stump, with a bleeding branch of gastro-duodenal artery at the bottom. Hemorrhage was stopped with stitches. Two years later a new episode of duodenal bleeding associated with severe malnutrition occurred. A covered chronic ischemic perforation sustained by duodenal distension due to biliopancreatic limb sub-obstruction appeared to be the most probable etiology of the recurrent duodenal bleeding. The patient underwent again to laparotomy and adhesiolysis; hemorrhage was stopped by means of ligation of gastroduodenal artery and bilio-pancreatic diversion was converted into a standard Roux-en-Y gastroenterostomy with an entero-entero anastomosis 40 cm from the Treitz ligament in order to restore an anatomo-functional condition guaranteeing normal absorption and intestinal transit. After Scopinaro’s bilio-pancreatic diversion duodenal bleeding can represent a rare serious presentation of biliopancreatic limb obstruction; because of the complex anatomical reconstruction performed during this intervention, the duodenum results unavailable during upper gastro-intestinal endoscopy, and if a duodenal bleeding is suspected laparotomy followed by enteroscopy represents an effective diagnostic approach.
机译：Scopinaro的胆胰转移术被认为是治疗病态肥胖的可接受的吸收不良手术方法。我们描述了一名先前患有Scopinaro胆汁-胰腺转移的患者的急性胃肠道反复出血的病例。在我科首次入院时，胃镜检查，结肠镜检查，对比增强的计算机断层扫描和血管造影检查发现活动性出血为阴性。降血脂性休克表明要进行剖腹手术，术中通过小肠切开术进行的肠镜检查显示溃疡性穿孔起源于扩张的十二指肠残端的缺血部分，胃十二指肠动脉的分支出血。缝合止血。两年后，新的十二指肠出血与严重营养不良有关。由胆胰胰四肢亚阻塞引起的十二指肠扩张引起的慢性缺血性穿孔似乎是复发性十二指肠出血的最可能病因。患者再次进行了剖腹术和粘连术；通过结扎胃十二指肠动脉止血，将胆管-胰管转移转换为标准的Roux-en-Y胃肠造口术，并在距Treitz韧带40 cm处进行肠-肠吻合，以恢复解剖功能，确保正常吸收和肠道运输。 Scopinaro的胆胰转移后，十二指肠出血可罕见地严重代表胆胰四肢阻塞。由于在此干预过程中进行了复杂的解剖重建，因此在上消化道内窥镜检查期间无法获得十二指肠的结果，如果怀疑十二指肠出血，然后再进行肠镜检查是一种有效的诊断方法。

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  • 来源
    《Updates in Surgery》 |2011年第4期|297-300|共4页
  • 作者

    Mattia Garancini; Margherita Luperto; Alberto Delitala; Matteo Maternini; Franco Uggeri;

  • 作者单位

    Reparto di Chirurgia Generale Ospedale San Gerardo Università di Milano-Bicocca via Pergolesi 33 20052 Monza Italy;

    Reparto di Chirurgia Generale Ospedale San Gerardo Università di Milano-Bicocca via Pergolesi 33 20052 Monza Italy;

    Reparto di Chirurgia Generale Ospedale San Gerardo Università di Milano-Bicocca via Pergolesi 33 20052 Monza Italy;

    Reparto di Chirurgia Generale Ospedale San Gerardo Università di Milano-Bicocca via Pergolesi 33 20052 Monza Italy;

    Reparto di Chirurgia Generale Ospedale San Gerardo Università di Milano-Bicocca via Pergolesi 33 20052 Monza Italy;

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  • 正文语种 eng
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  • 关键词

    Bleeding; Duodenal ulcer; Bilio-pancreatic diversion; Enteroscopy;

    机译：出血;十二指肠溃疡;胆胰转移;肠镜检查;

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