A 30 year old male patient presented with massive hemetemesis. On upper GI scopy, 3x2 cm ulcer was seen on the posterior aspect of 1st pa of the duodenum. Bleeding vessel seen, but could not be controlled endoscopically. Pulse rate 100, BP 110/70, Hb 10 gms% after blood transfusion. What will be the next line of management?
For patients bleeding from duodenal ulcers, truncal vagotomy, pyloroplasty, and oversewing of the bleeding vessel is the most widely used operation. Ref: Endoscopy of the Upper GI Tract: A Training Manual edited by Behold Block, Guido Schachschal, Hamut Schmidt (M.D.),2004, Page 151 - 154; Esophagus, Stomach, Duodenum edited by Karl Kremer, 1989, Page 237.
Paial gastrectomy including the bleeding segment
Duodenotomy, Truncal vagotomy, ligation of bleeding vessels and Pyloroplasty
Duodenotomy, pyloroplasty, Truncal vagotomy
IV Pantoprazole