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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