PANCREATIC BILIARY COMPLICATIONS OF DUODENAL ULCER

Abstract

Aim. To improve the diagnosis and surgical treatment of pancreatic-biliary complications of peptic ulcer disease.

Material and methods. This work is based on surgery of 74 patients with pancreatic-biliary complications (PBC) of duodenal ulcer (DU). The interpretation of clinical data showed that from 74 patients, 45 (60.8%) had manifestations of the pancreatic syndrome, 21 (28.4%) had the biliary syndrome and 8 (10.8%) had mixed pancreatic and biliary syndrome.

Results. Clinical manifestations of PBC of DU are usually atypical and observed in a form of 3 clinical syndromes. In case of penetration of duodenal ulcer into the head of the pancreas (n = 28) and major duodenal papilla (n = 17), clinical signs of indurative chronic pancreatitis with high activity of pancreatic enzymes in the blood and urine were observed. In the 18 cases of ulcers penetration to the common bile duct, the clinical picture of lesions of the biliary tree with persistent pain and recurrent jaundice dominated. In 31 observations, the clinical picture of biliary syndrome showed domination of cholangitis signs due to the formation of the choledochoduodenal fistula.

Conclusion. The clinical picture of PBC is atypical and accompanied by the presence of various complications. The surgical approach is non-standard and requires performance of the primary resection of the stomach by Roux combined stem vagotomy and corrective interventions in the extrahepatic bile ducts on indications.