Title:Laparoscopic Treatment of Perforated Bleeding Gastric Ulcer

Aims: In the last hundred years much has been written on peptic ulcer disease and the treatment options for one of its most common complications: perforation. Laparoscopic repair of perforated peptic ulcer has been gaining popularity in recent years. Treatment for perforated ulcer can be performed laparoscopically in 85% of cases, making it possible to avoid a median laparotomy which can lead to wound infection and late eventration.

Methods: A 77-year-old male presented to emergency room with a three-hour history of progressively worsening epigastric pain and nausea. Physical examination revealed rebound tenderness compatible with an acute abdomen. A CT scan showed: important pneumoperitoneum unable to define the drilling point; distended stomach with plenty of fluid inside and dense content fundus/ body suggestive of active arterial bleeding .

Results: The patient was emergently taken to the operating room for diagnostic laparoscopy. Perforation shown in greater gastric curvature associated blood remnants. Gastrotomy for clot removal is done without observing active bleeding. The gastrotomy was repaired using standard stitches. All exudate was aspirated and the peritoneal cavity was irrigated with warm saline solution

The patient had an uncomplicated post-operative course. JP drain was removed and he was discharged one week after surgery.

Conclusion: The role of laparoscopic surgery in emergencies is well documented. Laparoscopic approach is indicated in any case of suspected gastroduodenal perforation and seems to offer the same advantages as for the vast majority of laparoscopic procedures. Laparoscopic surgery may therefore have a real place in the treatment of perforated peptic ulcer.

Keywords: Laparoscopic treatment; Perforated bleeding; Gastriculcer

Presented at

24th International Congress of the European Association for Endoscopic Surgery. Amsterdam 15-18 June 2016