Alia Abdulla, DO, Marc Neff, MD. University of Medicine and Dentistry of New Jersey
Introduction: Cirrhosis and End Stage Liver Disease (ESLD) are life threatening diseases that place patients at significant risk if emergent surgery is required. Studies have estimated mortality rates for patients undergoing surgery at 10% for those with Child class A, 30% for those with Child class B, and 76–82% for those with Child class C cirrhosis. If surgical intervention is required in these patients, laparoscopy can be utilized as an alternative to open abdominal interventions.
Methods: We report a case of a perforated duodenal ulcer in a 46 year old male with Child’s Class C cirrhosis, Grade 1 esophageal varices, and portal hypertensive gastropathy.
Results: A 1.5cm perforation in the anterior wall of the 1st portion of the duodenum was identified and repaired by reapproximating the edges using interrupted 3-0 silk. After no further leaking was identified from the ulcer, a fibrin tissue glue was used to cover the primary suture repair. Omentum was then placed over the primary repair.
Conclusion: This case illustrates the safety of a less invasive laparoscopic approach in the repair of perforated duodenal ulcer in a Child’s Class C cirrhotic patient. In considering this approach, the potential injury to other dilated loops of bowel must be weighed against the benefits of reduced morbidity an laparoscopic approach allows.
Program Number: P482