A modified surgical technique for the emergent treatment of giant ulcers concomitant with hemorrhage in the posterior wall of the duodenal bulb

Background: One of the most challenging and lethal complications of the giant duodenal ulcer is massive bleeding, but management of the bleeding ulcer and the difficult duodenal stump remains controversial. Methods: We developed a modified surgical technique involving a partial gastrectomy, duodenostomy, and a duodenostomy tube placed through the duodenal stump enveloped around an omental patch. The surface of the ulcer was closed with a fibrin sealant. Results: Between January 1994 and December 1999, 12 patients underwent this surgical technique. All of the patients had massive giant bleeding ulcers in the posterior wall of the duodenal bulb. No deaths occurred. The duodenostomy tubes were removed between postoperative days 12 and 22. The other complications after operation were few. The mean hospital stay was 18 days. No rebleeding or duodenal stump leaks were found within the 12- to 60-month follow-up. Conclusions: This technique completely eradicated the ulcer as seen at the 12- to 60-month postoperative follow-up examination