Natural Orifice Endoscopic Drainage of Perforated Duodenal Ulcer

Sam Pakraftar, MD, Chris Dwyer, MD, Harry W Sell, MD, Kurt Stahlfeld, MD. UPMC Mercy.

Objective of the study/technique: To determine whether natural orifice drainage of perforated ulcer disease is feasible.

Description of the methods: To treat a peforated duodenal ulcer associated with a large abcess cavity in the lesser sac in a patient who was a poor candidate for operative or percutaneous drainage, we electively placed a fenestrated feeding tube transnasally and through the duodenal perforation into the abcess cavity using endoscopic and fluoroscopic guidance. Medical management consisted of intermittent suction, TPN, Zosyn, and diflucan.

Prelimary results: Following transnasal placement of the fenestrated feeding tube into a ten cm abcess cavity in the lesser sac associated with a large duodenal ulcer, the abcess cavity resolved and the patient was discharged on hospital day ten on a regular diet. 

Conclusions/Expectations: In a select group of patients with perforated duodenal ulcer disease, natural orifice drainiage can avoid the morbidity associated with open surgery or percutaneous drainage. This technique could be expanded to drain abcess cavities associated with other organs.

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