Acute Massive Hemorrhage caused by Postbulbar Duodenal Ulcer: Report of a Case

Takamasa Takahashi, Naoko Kondo and Hiroshi Kohno

Department of Surgery, Nagoya Ekisaikai Hospital

A 46-year-old man undergoing low anterior protectomy for rectal cancer sufferd shock due to acute hemorrhage on postoperative day POD 10 days after surgery. Gastrointestinal investigation showed an ulcer of the bulbar duodenum that was not a confirmable source of hemorrhage. Although he appeared to recover after the ulcer was clipped, he fell into shock again the next day. In emergency laparotomy, we diagnosed postbulbar duodenal ulcer hemorrhage and conducted pancreatoduodenectomy. Leakage from the pancreatojejunostomy and subsequent perforation of an arterial aneurysm of the right colonic artery then occurred. We ligated the artery surgically. The man discharged 81 days after the pancreatoduodenectomy. This is, to our knowledge, the first report of successful pancreatoduodenectomy in a patient with an acute massive ulcer hemorrhage in postbulbar duodenum therapy.

Key words
postbulbar duodenal ulcer, acute hemorrhage

Reprint requests
Takamasa Takahashi Department of Surgery, Japanese Red Cross Nagoya First Hospital
3-35 Michishita-cho, Nakamura-ku, Nagoya, 453-8511 JAPAN

Accepted
January 31, 2007

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