Pyloric Ring, Pancreas and Papilla-saving Subtotal Duodenectomy for a Duodenal Submucosal Hematoma in a Patient with Hemophilia

Takashi Hashimoto, Juro Yura, Yasunobu Shimizu, Tatsuya Suzuki*, Masakazu Ishikawa*, Akira Mizuno*

First Department of Surgery, Nagoya City University Medical School
*Department of Surgery, Takahama Municipal Hospital

The subtotal duodenectomy was performed in a patient with hemophilia because of a massive and serious submucosal duodenal hematoma. The patient was a 15-year-old boy who was admitted to our hospital 18 hours after being kicked in the abdomen. The duodenectomy was performed with saving of the pyloric ring and the papilla. The reconstruction was performed without changing of anatomical situation; The duodenal bulbus was anastmosed to the jejunum which was placed in the post-duodenectomized space. The papilla was anastomosed to the jejunum as a patch. The postoperative gastrointestinal fluoroscopy was revealed a good pyloric function. However, cimetidine 200 mg/day was necessary to prevent duodenal anastmosal bleeding until the suture thread was removed by duodenal endscopy. The cause of anastomosal bleeding was considered as a result of hemophilia and for the duodenectomy was considered to be useful for any other benign duodenal diseases.

Key words
duodenal hematoma, duodenectomy, hemophilia

Reprint requests
Takashi Hashimoto First Department of Surgery, Nagoya City University Medical School
1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, 467 JAPAN

Accepted
December 13, 1989

To read the PDF file you will need Abobe Reader installed on your computer.