How do they fix a perforated duodenal ulcer?
Omental patching is a surgical procedure for treating perforated ulcers. It is also called a Graham patch after the surgeon who first performed this technique. This procedure uses a patch of the omentum to repair the injury because it is durable.
Omental patching may be combined with other procedures such as the resection of the vagus nerve that stimulates acid production (vagotomy) to reduce acid production in the stomach or combined with other surgical procedures in case of very large ulcers.
The medical treatment of Helicobacter pylori (H. pylori) infection and acidity is required. Diet and lifestyle modifications would have to be followed after the surgery to prevent the recurrence of ulcers. Sometimes, a perforated ulcer can seal itself by an adherent omentum. Hence, the patient may be managed with medical treatment instead of surgery.
An ulcer is discontinuation occurring on the external or internal surface of the body. Caused by trauma to the skin or a mucous membrane that does not heal, ulcers vary in width and depth. They can be painful and lead to severe complications. Ulcers can occur in the esophagus, stomach, and intestines (duodenum is the first part of the small intestine and connected to the stomach).
Ulcers occur when acid damages the lining of the digestive tract. The common causes of ulcers are bacteria Helicobacter pylori, improper diet habits, and medication that increases the stomach acid level (pain reliever group). If the ulcers are not treated appropriately, there is continuous damage to the lining of the digestive tract, and the depth of the ulcer increases, ultimately leading to complete perforation (a hole) and bleeding.
The omentum is a double-layered fatty tissue that covers and supports the intestines and organs in the abdomen. The omentum is made up of the greater omentum that is important storage for fat and the lesser omentum that connects the stomach and intestines to the liver.
How is an omental patch surgery performed?
Before the surgery
- The surgeon performs the complete physical assessment, and complete blood and radiological analyses before the surgery and takes informed consent from the patient.
During the surgery
- The surgery is performed under general anesthesia.
- Different types of incisions may be used during the surgery, but the upper midline incision is the most popular, which provides good surgical exposure.
- Once the bowel perforation is identified, sponges would be used to prevent further spillage of the stomach/intestinal contents at the perforation site.
- Sutures are placed to prevent the leakage from bringing the margins closer. The greater omentum is then detached from the intestines and stomach.
- Once the omentum is mobilized, it is then lengthened by dividing it according to the anatomic pattern of the vessels.
- The omentum is then transferred to the site required to patch and strengthen the sutured area (stitches).
- The applied tension to the sutures should be strong enough to stabilize the omentum in place but loose enough to preserve the omental blood supply. The surgical wound is then closed. A surgical drain may be inserted to drain the accumulated fluid and blood.
- A tube placed through the skin of the abdomen into the midsection of the small intestine (feeding jejunostomy tube) may be inserted to provide nutrition postoperatively.
- A laparoscopic omental patch closure of the perforated duodenal ulcer has become increasingly common. It is less invasive, and the recovery rate is fast.
- Multiple small incisions are made over the abdomen through which the laparoscope (a long, thin tube that has a tiny video camera and light on the end) and surgical instruments are inserted. A feeding jejunostomy tube may be inserted.
After the surgery
- Painkillers and antibiotics are administered after the surgery.
- The patient may have to stay in the hospital for three-seven days after the surgery.
- Feeding would be done through the jejunostomy feeding tube because oral feeding would be delayed until the patch heals.
- Intravenous nutritional therapy may be administered as an alternative to a feeding tube.
- Attention to nutrition in the postoperative period is important to improve the health status of the patients and ensure adequate healing.
- Pain, swelling, and bruising is normal in the postoperative period and usually resolves within two weeks.
- Complete recovery can take four to six weeks.
What are the complications of an omental patch surgery?
The success rate of the surgery is high. Some complications that may be encountered are:
Health Solutions From Our Sponsors
Medscape Medical Reference
Top How Do They Fix a Perforated Duodenal Ulcer Related Articles
Crohn's Disease vs. Ulcerative Colitis (UC)Crohn's disease and ulcerative colitis are diseases that cause inflammation of part of or the entire digestive tract (GI). Crohn's affects the entire GI tract (from the mouth to the anus), while ulcerative colitis or ulcerative colitis only affects the large and small intestine and ilium. Researchers do not know the exact cause of either disease. About 20% of people with Crohn's disease also have a family member with the disease. Researchers believe that certain factors may play a role in causing UC. Both Crohn's disease and ulcerative colitis are a type of inflammatory bowel disease, or IBD.
Crohn's disease and ulcerative colitis both have similar symptoms and signs, for example, nausea, loss of appetite, fatigue, weight loss, episodic and/or persistent diarrhea, fever, abdominal pain and cramping, rectal bleeding, bloody stools, joint pain and soreness, eye redness, or pain. Symptoms unique to Crohn’s disease include anemia and skin changes. Symptoms of unique to ulcerative colitis include, certain rashes, an urgency to defecate (have a bowel movement). Doctors diagnose both diseases with similar tests and procedures. While there is no cure for either disease, doctors and other health care professionals can help you treat disease flares, and manage your Crohn's or ulcerative colitis with medication, diet, nutritional supplements, and/or surgery.
Visual Guide to Stomach UlcersLearn about the causes and symptoms of stomach ulcers, and find out which kinds of treatment can help.
Is Ulcerative Colitis Curable?Ulcerative colitis is an inflammatory bowel disease (IBD) that affects the inner lining of the large intestine (large bowel or colon) leading to erosion and ulcers. It is also associated with various manifestations outside of the colon, such as inflammation of the eyes, joints, skin, and lungs. Ulcerative colitis is a lifelong illness with no specific cause or cure. Patients have repeated cycles of flare-ups and disappearance of the disease.
Nonsteroidal Anti-inflammatory Drugs and UlcersNonsteroidal antiinflammatory drugs (NSAIDs) are prescribed medications for the treatment of inflammatory conditions. Examples of NSAIDs include aspirin, ibuprofen, naproxen, and more. One common side effect of NSAIDs is peptic ulcer (ulcers of the esophagus, stomach, or duodenum). Side effects, drug interactions, warnings and precautions, and patient safety information should be reviewed prior to taking NSAIDs.
Peptic Ulcer (Stomach Ulcer)Peptic or stomach ulcers are ulcers are an ulcer in the lining of the stomach, duodenum, or esophagus. Ulcer formation is related to H. pylori bacteria in the stomach, use of anti-inflammatory medications, and cigarette smoking. Symptoms of peptic or stomach ulcers include abdominal burning or hunger pain, indigestion, and abdominal discomfort after meals. Treatment for stomach ulcers depends upon the cause.
Peptic Ulcer PictureA hole in the lining of the stomach, duodenum, or esophagus. See a picture of Peptic Ulcer and learn more about the health topic.
Ulcerative ColitisUlcerative colitis is a chronic inflammation of the colon. Symptoms include abdominal pain, diarrhea, and rectal bleeding. Ulcerative colitis is closely related to Crohn's disease, and together they are referred to as inflammatory bowel disease. Treatment depends upon the type of ulcerative colitis diagnosed.
Ulcerative Colitis QuizWhat is ulcerative colitis and what risks are associated with suffering over the long term? Take this Ulcerative Colitis Quiz to learn causes, symptoms, and treatments for this painful digestive disorder.
Ulcerative Colitis Diet Plan
An ulcerative colitis diet plan can help a person with the disease avoid foods and drinks that trigger flares. There also are foods that can soothe ulcerative colitis symptoms during a flare. Types of ulcerative colitis plans include
- a high-calorie diet,
- a lactose-free diet,
- a low-fat diet,
- a low-fiber diet (low-residue diet), or
- a low-salt diet.
Self-management of ulcerative colitis using healthy lifestyle habits and a nutrient rich diet can be effective in management of the disease. Learn what foods to avoid that aggravate, and what foods help symptoms of the disease and increase bowel inflammation.
Ulcerative ColitisUlcerative Colitis is a form of inflammatory bowel disease and is slightly different than Crohn's disease. Your diet can impact the severity of your symptoms. Learn the causes, symptoms, and treatment options associated with ulcerative colitis.
Ulcerative Colitis SurgeryUlcerative colitis surgery is performed on approximately 25% to 40% of people with the disease. There are various types of ulcerative colitis. Complications of the surgery include pouch failure, intestinal blockage from adhesions, inflammation of the pouch, and more watery and frequent bowel movements.