A Case of Laparoscopic Repair for Perforated Duodenal Ulcer using the Ligamentum Teres Hepatis

Yutaka Shibata, Yasuhiko Nakagawa and Masashi Kodama

Department of Surgery, Kotoh General Hospital

A 42-year-old man admitted for right lateral abdominal pain was found in chest radiography and abdominal CT to have free air in the peritoneal cavity. Endoscopic examination suggested a perforated duodenal ulcer necessitating emergency laparoscopic surgery with lifting method. Two pieces of Kirschner wire were obliquely inserted and raised to obtain working space. Five trocars were then inserted into the peritoneal cavity; under umblication (5 mm in diameter, scope port), below xyphoid (11 mm), right upper and lower abdomen (5 mm) and left upper abdomen (5 mm), Laparoscopy showed a perforated ulcer in the anterior wall of the duodenum. Since the large omentum was too short due to inflamation, it was difficult to conduct a laparoscopic omental patch repair. We have done laparoscopic repair of perforated duodenal ulcer using the ligamentum teres hepatis. The operation took 120 minutes. The postoperative course was uneventful. Endoscopic examination on postoperative day 14 showed an H1-H2 stage ulcer. He underwent therapy to eradicate Helicobacter pylori. No further ulcers have recurred in the 6 weeks following. Laparoscopic repair using the ligamentum teres hepatis is thus useful in treating perforated duodenal ulcers.

Key words
perforated duodenal ulcer, laparoscopic surgery, ligamentum teres hepatis

Reprint requests
Yutaka Shibata Department of Surgery, Kotoh General Hospital
37 Kaiho, Kawasaki, Hachirogata-machi, Minamiakita-gun, 018-1605 JAPAN

Accepted
November 30, 2005

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