A RARE COMPLICATION OF CHRONIC DUODENAL ULCER

Background. Complications of chronic gastroduodenal ulcers remain a pressing issue despite the optimization of conservative treatment of gastric and duodenal ulcers. The almost complete rejection of planned surgical treatment and the development of complications of ulcer disease in some cases have led to an increase in the number of emergency surgeries, in which there is a high probability of unfavorable outcomes. The main tasks in solving this problem are still timely diagnostics of resistant cases of therapy and timely prescription of adequate surgical treatment. The combination of various complications of peptic ulcer disease, especially atypical ones, such as choledochoduodenal and cholecys-toduodenal fistulas, gives non-specific and diverse clinical manifestations. This has a significant impact on the disease course and diagnostics. The choice of treatment tactics for this category of patients is individual.
Case description. A rare clinical observation is presented – a combination of several complications, including atypical ones, of a chronic ulcer of the duodenal bulb. A 58-year-old man was admitted to the surgical department with back and epigastric pain, vomiting mucus, and had not been examined before. Endoscopic examination revealed a chronic ulcer of the duodenum complicated by bleeding, penetration, and duodenal fistula. Ultrasound examination and computed tomography allowed only to determine the signs of acute cholecystitis. According to absolute indica-tions, laparotomy was performed. During revision, the diagnosis was clarified, a chronic ulcer of the duodenal bulb with penetration into the hepatoduodenal ligament, two fistulas – cholecystoduodenal (between Hartmann’s pouch and the ulcer) and choledochoduodenal, acute cholecystitis were detected. 
Conclusion. The clinical example demonstrates a combination of several complications of chronic duodenal ulcer, including atypical ones. The chosen treatment tactics allowed the patient to recover.

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