Surgical Treatment Protocol for Duodenal Perforation Near the Papilla

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  • 十二指腸乳頭部近傍の穿孔に対する外科的治療方針
  • 臨床経験 十二指腸乳頭部近傍の穿孔に対する外科的治療方針
  • リンショウ ケイケン ジュウニシチョウ ニュウトウブ キンボウ ノ センコウ ニ タイスル ゲカテキ チリョウ ホウシン

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Abstract

[Purpose] Standard treatment protocols or surgical methods for treating perforations near the duodenal papilla are not established. We aimed to determine an appropriate treatment protocol after reviewing operative outcomes of cases of perforation near the duodenal papilla.<BR>[Objectives and Methods] We reviewed the findings of eight cases where patients had been operated on for perforation near the duodenal papilla, in our hospital, from January 2008 to December 2015. We evaluated the relationships between time from the onset to operation, intraoperative inflammation, degree of peritonitis, and short-term outcomes. The treatment protocol in our hospital involves operating as soon as possible after diagnosis, and we performing simple closure if intraoperative inflammation and peritonitis are mild to moderate.<BR>[Result] The mean time to operation from symptom onset was 16.1 h. Inflammation and peritonitis became more severe as time to operation increased. Complications were detected in three cases ; none was greater than Clavien-Dindo IIIb, and no patient died during hospitalization.<BR>[Conclusion] Good results may be achieved by performing simple closure in cases with slight inflammation and peritonitis. Surgery should be performed as soon as possible because the degree of inflammation and peritonitis is related to the time to operation.

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