Dr. Mehreen Saba Khurram, Dr. Maryam Shahid, Dr. Muhammad Ayaz Janjua
Aim: To supervise and share experience in the treatment of duodenal ulcer bleeding, which is a rare surgical procedure during comprehensive treatment. Study design: case series. Place and duration: In the Department of Surgery Holy Family Hospital Rawalpindi for one year duration from March 2019 to March 2020. Method: Retrospective study of 14 patients treated with duodenal ulcer bleeding. Data were obtained from the hospital register and patient files. All patients initially reported to the hospital's gastrointestinal ward. Bleeding from duodenal ulcer was diagnosed in all patients by endoscopy. Surgical indications after resuscitation were the inability to stop bleeding medically or by endoscopic means, 6 units of blood demand during follow-up, unstable patients, very low hemoglobin and a rare blood group. Results: The average age in this group was 46.11. (79%) of patients were subjected to emergency in shock. Long-term non-steroidal anti-inflammatory drugs (NSAIDs) were given to 6 (43%) patients. In endoscopy, 11 (79%) patients had a posterior bulber ulcer, and 3 (23%) had an anterior ulcer. During the surgery, it was observed that only 1 of these 3 patients had anterior ulcer and the other 2 had a posterior ulcer. Posterior suture ligation (SL) was performed along with bilateral trunkal vagotomy (TV) and pyloroplasty (PP). For anterior ulcer duodenostomy closure taking ulcer in suture line was done. Re-bleeding was observed in 2 (14%) patients and one of them had excision of the ulcer before resection and bilroth-II reconstruction in the other patient and embolism of the gastro-duodenal artery aneurysm in the other. Other postoperative complications were pneumonia (22%), wound infection (22%), arrhythmias (7%) and duodenal stump leakage (7%). Conclusion: During this period of medical and endoscopic progression, surgical intervention plays a decisive role in detecting bleeding from duodenal ulcer with acceptable morbidity and mortality. KEY WORDS: Duodenal ulcer, bleeding, rescue operation.