Pancreas-sparing duodenectomy for kissing duodenal ulcers spawned by refractory peptic ulcer disease: case report with technical note and literature review

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Abstract
Peptic ulcer disease is a common condition that affects ~4 million people worldwide, according to a 1984 estimate. However, concomitant perforation of dual anterior and posterior ulcerations (so-called ‘kissing ulcers’) is rare and presents significant surgical challenges with high morbidity and mortality. Such scenarios present surgical challenges and impose very high-level morbidity and mortality. A 76-year-old man described herein required emergency treatment for duodenal peptic ulcer perforation. Overall, three operations took place in response to a single anterior peptic ulcer of duodenum that culminated in anterior/posterior kissing ulcers. Pancreas-sparing duodenectomy was performed as a final attempt, along with radiographic localisation of the papilla. This rare instance of duodenal peptic ulceration underscores the feasibility and importance of a more definitive approach after ineffective initial surgical intervention.

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