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Revista do Colégio Brasileiro de Cirurgiões

Print version ISSN 0100-6991On-line version ISSN 1809-4546


GOFFI, Fábio Schmidt; GOFFI JUNIOR, Paulo Schmidt; BROMBERG, Sansom Henrique  and  GONCALVES JUNIOR, José. Penetrating peptic ulcer into the head of pancreas: surgical conduct for the difficult duodenum. Rev. Col. Bras. Cir. [online]. 1999, vol.26, n.5, pp.291-204. ISSN 1809-4546.

Beginning in the 1970s, many duodenal ulcers have been adequately managed using H2 receptor blockers or proton pump inhibitors associated to antimicrobial agents. However in the bleeding penetrating duodenal ulcer when the endoscopic treatment is lacking, the severe character of the hemorrhage and the frequence of the recurrence sometimes impose a radical surgery as early as possible, in spite of technical difficulties. Considering these facts, a surgical approach to the duodenal dissection during the gastroduodenectomy for penetrating ulcers is presented. This maneuver basically consist of (1) the adequate retrograde liberation of the descending portion of duodenum, (2) the oblique section of the duodenum at the lower border of the ulcer and (3) the introduction of the surgeon's forefinger into the duodenal lumen in order to facilitate the wall liberation from the pancreas achieved through a blunt dissection with a fine scissor or a Halsted forceps. The duodenal stump is now prepared for a gastroduodenal anastomosis or for closure by suture previously to a gastrojejunostomy. This technique have been used by one of us for many times with fairly good results.

Keywords : Penetrating duodenal ulcer; Gastrointestinal bleeding; Gastroduodenal  resection.

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