Department of Surgery, NTT Medical Center Tokyo, Tokyo, Japan.
Department of Gastrointestinal Endoscopy, NTT Medical Center Tokyo, Tokyo, Japan.
Clin J Gastroenterol. 2023 Oct;16(5):761-766. doi: 10.1007/s12328-023-01823-9. Epub 2023 Jun 30.
A 71-year-old woman underwent endoscopic submucosal dissection for early duodenal cancer at the second portion of the duodenum and developed acute peritonitis due to delayed duodenal perforation. Emergency laparotomy was performed. A huge perforation formed at the descending duodenum without ampulla involvement. Pancreas-sparing partial duodenectomy (PPD) with gastrojejunostomy was performed (250 min operative time) with 50 mL of intraoperative blood loss. She required intensive care for 3 days and was discharged on postoperative day 21 with no severe complications. Emergency treatment for a major duodenal injury or perforation remains challenging because of high morbidity and mortality. An appropriate treatment should be considered according to the nature of the defect. Although PPD is an acceptable procedure for patients with a duodenal neoplasm, its use in emergency surgery is rarely reported. PPD is more reliable than primary repair or anastomosis using a jejunal wall, and less invasive than pancreaticoduodenectomy, for emergency treatment. We performed PPD in this patient because the duodenal perforation was too large to reconstruct and did not involve the ampulla. PPD can be a safe and feasible alternative surgical procedure to pancreaticoduodenectomy for a major duodenal perforation, especially in patients with a duodenal perforation that does not involve the ampulla.
一位 71 岁女性因十二指肠第二段的早期癌接受了内镜黏膜下剥离术，因十二指肠延迟穿孔而发生急性腹膜炎。紧急剖腹手术。降段十二指肠形成了一个巨大的穿孔，没有壶腹受累。行保留胰脏的部分十二指肠切除术（PPD）和胃空肠吻合术（手术时间 250 分钟），术中失血 50 毫升。她需要重症监护 3 天，术后第 21 天无严重并发症出院。由于高发病率和死亡率，对严重十二指肠损伤或穿孔的紧急治疗仍然具有挑战性。应根据损伤的性质考虑适当的治疗方法。尽管 PPD 对十二指肠肿瘤患者是一种可接受的手术，但在急诊手术中很少有报道。对于紧急治疗，PPD 比使用空肠壁的一期修复或吻合更可靠，比胰十二指肠切除术创伤更小。我们对这名患者进行了 PPD，因为十二指肠穿孔太大，无法重建，且不涉及壶腹。对于严重的十二指肠穿孔，PPD 可以作为胰十二指肠切除术的一种安全可行的替代手术方法，尤其是在不涉及壶腹的十二指肠穿孔患者中。
