A METHOD OF OPERATIVE HEMOSTASIS AT BLEEDING ULCERS OF THE BACK WALL OF THE DUODENAL BULB

617-089.844

10.21685/2072-3032-2017-4-9

Background. The problem of homeostasis in patients with relapses of duodenal ulcer with a high risk of complications is topical due to the high mortality and the percentage of disability. In this regard, it is necessary to develop a low-traumatic method of operative homeostasis at bleeding duodenal ulcers.
Materials and methods. The study was conducted in the surgical departments of the Emergency Hospital in Dzerzhinsk, Nizhny Novgorod region, between 2010 and 2015. The article analyzes the results of treatment of 54 patients admitted to hospital in an emergency with the clinical picture of ulcer of the posterior wall of the bulb of the duodenum complicated by bleeding.
Results. The work presents clinical experience of using a new method of hemostasis at bleeding ulcers of the posterior wall of the duodenum. The method consists in retrograde catheterization, dressing and crossing of a. gastroduodenalis, supplying blood to the back wall of the duodenum. Catheterization is carried out through a.gastro-epiploica dextra, which eliminates the need for traumatic revision in the retroduodenal space. 13 patients with recurrent bleeding from the bulb of the duodenum were operated following the developed method.
Conclusion. The most important feature of the developed method of hemostasis is the absence of the need for additional interventions in the retro-duodenal space, the ability to reliably stop the blood flow. No mortality and recurrence of bleeding have been registered when using this method.

ulcer of duodenal bulb, bleeding, hemostasis, ligation of arteries throughout

1. Bagnenko S. F., Sinchenko G. I., Verbitskiy V. G., Kurygin A. A. Vestnik khirurgii [Bulletin of surgery]. 2007, vol. 166, no. 4, pp. 71–75.
2. Baleev M. S., Ryabkov M. G., Kiseleva E. B., Mitrofanova N. N., Mel'nikov V. L. Izvestiya vysshikh uchebnykh zavedeniy. Povolzhskiy region. Meditsinskie nauki [University proceedings. Volga region. Medical sciences]. 2017, no. 3 (43), pp. 95–107.
3. Repin V. N., Chudinov A. A., Gudkov O. S., Repin M. V., Ryzhakov A. P., Kostin V. A. Permskiy meditsinskiy zhurnal [Perm medical journal]. 2014, no. 4, pp. 6–11.
4. Gostishchev V. K., Evseev M. A. Khirurgiya [Surgery]. 2007, no. 7, pp. 7–11.
5. Malkov I. S., Nasrullaev M. N., Zakirova G. R., Khamzin I. I. Kazanskiy meditsinskiy zhurnal [Kazan medical journal]. 2016, no. 6, pp. 832–837.
6. Kondratenko P. G., Radenko E. E., Zharikov S. O. Ukrainskiy zhurnal khirurgii [Ukranian journal of surgery]. 2014, no. 1 (24), pp. 111–116.
7. Kvashin A. I., Atamanov S. A., Mel'nik A. V., Bykov A. O., Pomkin A. A., Shirkin M. G., Portnyagin A. F., Pacherskikh F. N. Mezhdunarodnyy zhurnal intenventsionnoy kardioangiologii [International journal of intervention cardioangiology]. 2012, no. 31, pp. 19–25.