Úlcera péptica terebrante na cabeça do pâncreas: conduta cirúrgica no chamado duodeno difícil

• Autor(a) principal: Goffi, Fábio Schmidt
• Data de Publicação: 1999
• Outros Autores: Goffi Júnior, Paulo Schmidt, Bromberg, Sansom Henrique [UNIFESP], Gonçalves Junior, José
• Tipo de documento: Artigo
• Idioma: por
• Título da fonte: Repositório Institucional da UNIFESP
• Texto Completo: http://dx.doi.org/10.1590/S0100-69911999000500007; http://repositorio.unifesp.br/handle/11600/835
• topic: Penetrating duodenal ulcer; Gastrointestinal bleeding; Gastroduodenal resection; Úlcera péptica terebrante; Gastroduodenectomia; Hemorragia digestiva

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.