Laparoscopic repair of perforated duodenal ulcer with a modified Graham patch.

John H Rodriguez, MD, Diya Alaedeen, MD

Fairview Hospital

Laparoscopy has played an important role in the management of complications of peptic ulcer disease. We present the case of a 64 year old female that presented to the emergency room with abdominal pain 9 days after an elective laparoscopic cholecystectomy. A computed tomography revealed the presence of a large amount of pneumoperitoneum. She was taken to the operating room emergently. During diagnostic laparoscopy she was found to have a 1 cm perforation in the first portion of the duodenum. The perforation was closed primarily and an omental pedicle was then secured over the top. An upper endoscopy was performed which revealed a persistent leak. The perforation was further reinforced using the falciform ligament and a hemostatic matrix. Intra-abdominal drains were then placed. An upper gastrointestinal study performed on-post operative day 3 showed no contrast extravasation. She was later discharged home in excellent condition. Laparoscopy continues to be a useful tool in the management of perforated duodenal ulcers in the community setting.

Session: Poster Presentation

Program Number: P246

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