[Hemorrhagic juxtapapillary duodenal ulcer with choledochal and Wirsung's duct stenosis and duodenojejunal fistula following biliojejunal en-Y diversion. The surgical solution].

The paper reports on the clinical observation of a patient with bulbar duodenal ulcer placed in a juxtapapillary position due to a short bile duct, complicated with choledochal and Wirsung's stenosis and, finally haemorrhage and duodenojejunal fistula favoured by a gallbladder-jejunum diversion assembly. Three major surgeries, during 17 years, were required: cholecystectomy and choledochoduodenostomy for the choledochal stenosis induced by penetrating posterior bulbar ulcer; after 8 years, choledocholithotomy and gallbladder-jejunum derivation the loop in Y, (Roux) for the choledochoduodenostomy stenosis with the local lithiasis of the CBP; after 9 years, the resection of the proximal segment of the anastomosed jejunal loop with CBP and gastric resection with ulcer exeresis, followed by restoration of the gallbladder-jejunum anastomosis, gastrojejunal anastomosis and reimplantation of Wirsung's duct in the duodenal stump for juxtapapillary duodenal ulcer complicated with haemorrhage, penetration into pancreas, perforation in the jejunal loop anastomosed preduodenally and stenosis of Wirsung's duct. The final therapeutic result is good and lasts in time. The paper discusses the duodenum-gallbladder-pancreas interrelationships in the juxtapapillary ulcers, drawing the attention on the possibility of forming a duodenojejunal fistula in the patients with gallbladder-jejunum derivations.