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Case Reports
. 2003 Oct-Dec;7(4):377-82.

Laparoscopic suture repair of a perforated gastric ulcer in a severely cirrhotic patient with portal hypertension: first case report

Paolo Gentileschi  1 , Piero Rossi, Antonio Manzelli, Francesca Lirosi, Francesca Susanna, Vito Maria Stolfi, Claudio Spina, Achille L Gaspari
Affiliations
Case Reports

Laparoscopic suture repair of a perforated gastric ulcer in a severely cirrhotic patient with portal hypertension: first case report

Paolo Gentileschi et al. JSLS. 2003 Oct-Dec.

Abstract

Background: Open digestive surgery in cirrhotic patients is associated with high morbidity and mortality. Laparoscopy in this setting has the potential to reduce postoperative complications. Laparoscopic treatment of a perforated gastric ulcer in a severely cirrhotic patient with portal hypertension is herein described.

Methods: A 75-year-old woman affected by cirrhosis of the liver (Child class C) and chronic gastric ulcer presented with acute abdominal pain. The diagnosis of perforation was made with plain films of the abdomen and computed tomography. Diagnostic laparoscopy showed intense peritonitis due to a perforated ulcer of the anterior gastric wall, 2 cm proximal to the pylorus. Suture closure and placement of an omental patch were performed laparoscopically.

Results: Postoperative recovery was complicated by a minor leak of the gastric suture, managed by total parenteral nutrition. Closure of the gastric wound was demonstrated by Gastrografin studies on the 10th postoperative day. The patient was discharged on the 16th postoperative day. At 3-months follow-up, the patient is alive and free of gastric disease.

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Figures

Figure 1.
Figure 1.
Free intraperitoneal air was clearly demonstrated by plain films of the abdomen.
Figure 2.
Figure 2.
CT scan confirmed the presence of free intraperitoneal air, showing subdiaphragmatic effusion.
Figure 3.
Figure 3.
A severe form of cirrhosis of the liver was confirmed by laparoscopy.
Figure 4.
Figure 4.
Laparoscopy revealed diffuse peritonitis.
Figure 5.
Figure 5.
A perforation, 1 cm in diameter, was demonstrated in the anterior wall of the stomach, 2 cm proximal to the pylorus.
Figure 6.
Figure 6.
Suture closure and intracorporeal knot-tying technique were performed.
Figure 7.
Figure 7.
An omental patch was also sutured to the gastric wall.
Figure 8.
Figure 8.
A minor leak from the gastric wound was observed with a Gastrografin study.
Figure 9.
Figure 9.
Complete closure of the gastric wound at Gastrografin study.
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