A case of successful diagnosis and treatment of atypical perforative giant duodenal ulcer

Abstract

A clinical case of successful diagnosis and treating of a perforated giant duodenal ulcer of 88-year-old patient who was staying in a surgical hospital for 3 days with a closed fracture of the right femoral neck is described.The patient had a mild abdominal pain syndrome, but there was no ulcerative history, percussion signs of free gas in the abdominal cavity, pronounced tension of the abdominal muscles, signs of irritation of the peritoneum.Diagnostics was hampered by the presence of senile layers and a number of concomitant somatic diseases of the heart, blood vessels, and metabolism.Hollow organ perforation was diagnosed by plain radiography in the patient's half-sitting position and in lateroposition.The operation revealed perforation of a giant ulcer of the anterior wall of the duodenum with pyloroduodenal stenosis.Despite the maximally high degree of operational risk, due to the impossibility of suturing (excising) the perforation, 2/3 of the stomach was resected according to Balfour.The case demonstrates the need for a personalized approach to the choice of surgical tactics in complex emergency clinical situations that go beyond the standard scope of clinical guidelines and instructions.