A Successfully Surgical Treated Case of a Duodenal Bleeding with Bleeding Shock after Chemotherapy in a Patient with Osteosarcoma, Occurring after a Cure of Malignant Lymphoma

Abstract

We successfully treated a case of duodenal bleeding with bleeding shock by jejunal patching in a patient with osteosarcoma after both radiation and chemotherapy. A 35-year-old woman was admitted to our hospital because of a tumor of her back. On admission, the tumor was biopsied, with a diagnosis of osteosarcoma. The patient had undergone chemotherapy. Her previous history showed she had undergone radiation therapy (70 Gy) and surgical treatment twice in the upper abdomen due to malignant lymphoma. She was critically ill, presenting symptoms of hematemesis and beeding shock. Under the diagnosis of duodenal bleeding, an emergency laparotomy was carried out. On laparotomy, massive sclerotic and edematous organs, stomach, duodenum and intestine, were recognized due to the previous radiation and chemotherapy. The duodenal ulcer had penetrated into the liver. Therefore, during the approach to the bleeding point, the duodenum was opened. Arterial bleeding was stopped by a 3.0 proline ligation. Jejunal patching (Roux-Y) for the anterior wall defect of the duodenum was then performed, and a gastrojejunostomy (Davine type) was added for the inhibition of re-bleeding. As for surgical technique, the jejunal patching was effective for duodenal defect repair. After discharge, the patient is doing well.