Clinical Challenges in Emergency General Surgery: Management of Duodenal Emergencies

Behind The Knife: The Surgery Podcast

Medicine, Health & Fitness, Education, Science

4.8 • 1.4K Ratings

🗓️ 15 August 2024

⏱️ 33 minutes

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Summary

Join our Emergency General Surgery team as we talk about the dreaded difficult duodenum. We discuss two cases on a common disease that has now become a rarity in surgical management. We cover principles of combined assessment and resuscitation, diagnosis and helpful adjuncts, and multidisciplinary and surgical management.

Hosts: Drs. Ashlie Nadler, Jordan Nantais and Graham Skelhorne-Gross

We have come a long way from managing duodenal emergencies with vagotomies since the widespread use of proton pump inhibitors. But surgeons and trainees still need to gain competence in managing duodenal emergencies, despite the dearth of operative interventions often encountered. We discuss the two most common presentations related to duodenal ulcers - bleeding and perforation. We focus on resuscitation, damage-control surgery, and the role of non-surgical management options.

Learning Objectives:
- Learn to investigate and resuscitate patients with upper gastrointestinal bleeding
- Develop an approach to the management of upper gastrointestinal bleeding
- Understand the risks and benefits of various surgical techniques for dealing with perforated duodenal ulcers

References:

Tarasconi, A., Coccolini, F., Biffl, W.L. et al. Perforated and bleeding peptic ulcer: WSES guidelines. World J Emerg Surg 15, 3 (2020). https://doi.org/10.1186/s13017-019-0283-9

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Transcript

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0:00.0	Behind the surgery podcast relevant and engaging content designed to help you dominate the day. Hi everyone and welcome to our ninth episode in emergency general surgery.
0:28.0	My name is Graham Schenle-Oren Gross.
0:29.7	We've got a great episode for you today, some really interesting cases and I'm joined as always by
0:35.4	Jordan Nana and Ashley Nadler.
0:37.6	Hello.
0:39.6	Hey.
0:41.6	So we figured it was about time that we talked about one of the most dreaded emergency general
0:46.0	surgery organs, the duodenum.
0:48.8	Yes, often in many cases referred to appropriately as the difficult duodenum?
0:53.2	Yes, it really is and there's many reasons for that. Part of it is that the incidence of
0:58.4	duodenal catastrophe has decreased over time, although it doesn't always feel like that, and we've developed a better understanding
1:04.6	and treatment for peptic ulcer disease, which caused the majority of due dinal surgical problems.
1:09.4	So we have less training and exposure to do a dinal surgical emergencies than I once had.
1:14.0	Yeah, I totally agree, Ashley. A lot of the surgeries that used to be calling place for
1:18.0	acid control like vaginies have fallen out of favor with the use of PBIs.
1:22.0	So most surgeons in practice now don't have any idea. have fallen out of favor with the use of PPI.
1:22.7	So most surgeons in practice now don't have any idea
1:25.1	what selective vague ot or me is,
1:27.1	I include myself as one of them,
1:28.9	and we rarely have to perform it
1:30.4	because it's just not necessary anymore.
1:33.0	Yeah, proton pump inhibitors have certainly done wonders, but you know, we still have issues with
	...

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