Manuel Aceves, MD1, Raul Perez, MD1, Arturo Martinez, MD1, Eduardo D Aceves, MD2. 1Obesidad y Laparoscopia Avanzada Puerta de Hierro Sur, 2Medicina Interna Hospital San Jose TEC de Monterrey
Since the use of drugs like histamine-2 blockers and proton pump inhibitors, the incidence of Peptic Ulcer Disease has decreased markedly. However, the incidence of Perforated Peptic Ulcer (PPU) has remained the same and it is still the most common indication for emergency gastric surgery.
67% are located in the duodenum and only 17% in the stomach.
There have been many studies comparing open vs laparoscopic approach without an agreement regarding which one is the best
We present a case of a 64 year old female with morbid obesity (49 BMI) and a bilateral pneumonic process that presents with acute abdominal pain 24h after her ICU stay because of a Perforated Gastric Ulcer.
We performed a laparoscopic approach finding a perforated ulcer with a 3 cm diameter in the posterior wall of the gastric body. We decided to perform a primary closure of the hole with intracorporeal sutures of Ethibond plus a pediculated omental patch with extensive wash-out and drainage of the abdominal cavity and transoperatory placement of endoscopy-guided nasoyeyunal tube for gastric decompression and early enteral nutrition.
The laparoscopic approach has all the advantages that minimally invasive surgery offers.
We think this must be the procedure of choice in these cases provided that the surgeon has the necessary experience and abilities in advanced laparoscopic surgery.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 77672
Program Number: V102
Presentation Session: Acute Care Surgery
Presentation Type: Video