Journal of Experimental and Clinical SurgeryJournal of Experimental and Clinical Surgery2070-478X2409-143XVoronezh State Medical University134610.18499/2070-478X-2020-13-2-135-137Research ArticleStaged Treatment of a Complicated Giant Gastric Ulcer: a clinical case reportDemchenkoVitaly<p>Associate Professor at the Department of Intermediate Course of Surgery and Transplantology</p>vita.dem64@yandex.ruhttps://orcid.org/0000-0002-8969-9158VlasovAlexander<p>Assistant Professor at the Department of Intermediate Course of Surgery and Transplantology</p>vlasovalexv@mail.ruhttps://orcid.org/0000-0002-8830-5073CheburkovaEugenia<p>Assistant Professor at the Department of Intermediate Course of Surgery and Transplantology</p>mahikan@mail.ruhttps://orcid.org/0000-0003-3672-3246Federal State Budgetary Educational Institution of Higher Education «Privolzhsky Research Medical University» of the Ministry of Health of the Russian Federation, Nizhny Novgorod, Russian Federation.2906202013213513708062019Copyright © 2020, Demchenko V., Vlasov A., Cheburkova E.2020<p>Introduction. The paper presents clinical outcomes of surgical treatment of a patient with a chronic giant gastric ulcer complicated by penetration into the pancreas, perforation of the anterior and posterior walls of the stomach and general purulent peritonitis. According to various data postoperative mortality in such patients ranges from 11.1% to 50%. In this regard, patients with giant penetrating ulcers need an individual approach and the issue of the optimal amount of surgical intervention still remains challenging. <br />Methods. The damage control method and staged surgical interventions were applied in the treatment of this patient. At the first stage, the perforation hole on the back wall of the stomach was sutured with a double-row interrupted suture, the hole on the front wall was sutured using a pedunculated omentum, and sanitation of the abdominal cavity was performed. Postoperative intensive complex treatment was carried out in the intensive care unit. <br />Results. After two days of treatment a planned relaparotomy (the Billroth II operation modified by Braun-Balfour) with resection of 2/3 part of the stomach was performed. The postoperative macrosection demonstrated that the size of the ulcer was 18.0x10.0 cm. The postoperative period was complicated: the intestinal paresis resolved in 5 days, there was a left lower lobe pleuropneumonia in the lungs suppuration of the postoperative wound. The patient recovered and was discharged in 25 days after hospitalization.</p>Stage surgical treatmentclinical observationperforated gastric ulcergeneral purulent peritonitis“damage control”.Клинический случайпрободная язва желудка, распространенный гнойный перитонит, «damage control», этапное хирургическое лечение.[1. Sovtsov SA. Chronicle of private surgery. Part 2: Perforative ulcer, monograph. Chelyabinsk: Tsitsero. 2016. 165 s. (In Russ)][2. Sazhin VP., Bronshtein PG., Zaitsev OV., Kondrus IV., Krivtsov GA., Lobankov VM., et al. National clinical recommendations "Perforated ulcer". The XII Congress of surgeons of Russia "Topical issues of surgery". Rostov-on-Don, on October 7-9 2015. 37 p. (In Russ)][3. Moggia E, Athanasopoulos P, Hadjittofi C, Berti S. Laparoscopic Finney pyloroplasty in the emergency setting: first case report in the literature and technical challenges. Ann Transl Med. 2016;4(10):197-197. Doi:10.21037/atm.2016.04.09][4. Zharov SV., Narezkin DV., Romanenkov SN. Operative treatment results of elderly and senile patients with complicated giant ulcers of the stomach and duodenum. Novosti khirurgii. 2012. 20 (2). P. 25–28. (In Russ)][5. Mukhopadhyay M, Banerjee C, Sarkar S, Roy D, Rahman Q. Comparative Study Between Omentopexy and Omental Plugging in Treatment of Giant Peptic Perforation. Indian Journal of Surgery. 2011; 73(5):341-345. Doi:10.1007/s12262-011-0320-8][6. Shaposhnikov RA., Manuk'yan GV., Shertsinger AG. Modern use of tactics of multi-stage operations and the reduced laparotomy in an urgent surgery. The Surgeon. 2009; 1. P. 55-59. (In Russ)][7. Timerbulatov MV., Timerbulatov SV., Yarmukhametov IM. “Damage control” and “bail out” step-wise operations in urgent abdominal surgery. Creative surgery and oncology. 2012;(1):103-107. Doi: 10.24060/2076-3093-2012-0-1-103-107. (In Russ.)][8. Savel'ev VS., Gel'fand BR, Filimonov MI, editors. Peritonitis: practical guidance. Moscow: Litterra 2006. (In Russ)]