Ulcerate pyloroduodenal stenosis in children and the role of helicobacteriosis in its development

Purpose of the study. Diagnosis of the degree of pyloroduodenostenosis (PDS) and the role of helicobacteriosis in its development, development of preoperative preparation and surgical tactics.

Material and research methods. This work is based on the results of examination and surgical treatment of 48 patients with duodenal ulcer (duodenal ulcer) complicated by PDS. Prior to admission to the clinic, all patients received multiple conservative antiulcer treatment. Stenosis of the proximal third of the duodenal bulb was diagnosed in 8 (16.7%) patients, the middle third in 17 (35.4%) and postbulbar stenosis in 23 (47.9%). Indications for surgery were determined depending on the clinical course of the disease, the stage of stenosis, the degree of motor evacuation function disorders (MEF) of the stomach and duodenum, as well as the characteristics of gastric secretion, the degree of endogenous intoxication (EI). For the diagnosis of H. pylori infection, a rapid urease

test, morphological and bacteriological research methods were used.

Results of the study and their discussion. In 89.1% of patients, pyloroduodenal stenosis was accompanied by an active ulcerative process upon admission. Most often, duodenal ulcers were combined with gastroesophageal and duodenogastric reflux. Fundic and 91.3% erosive antral gastritis were observed in 36.9% of patients. Ulcers leading to PDS in children were localized in the pyloric 8 (16.7%), bulbar 18 (39.1%) and postbulbar 22 (45.8%) parts of the duodenum.

Depending on the nature of the response to the administration of cerucal, three types of changes in intragastric pressure were identified.

In all children with PDS, the level of basal secretion of hydrochloric acid was higher than normal. The average level of increase in the concentration of hydrochloric acid and basal secretion averaged 72.3±6.9 meq/l, with the volume of gastric juice 123±8.5 ml/hour, and the basal production of free hydrochloric acid was 10.7±1.2 meq/g

Preoperative preparation was carried out as follows: anti-helicobacter therapy.

In the immediate postoperative period, complications were observed in 5 (10.8%) children in the form of duodenal stump failure 1, gastrostasis 2 and pancreatitis 2. In the long term, positive results were obtained in 94.5% of children and in 2 (5, 5%) of children experienced unsatisfactory results.

Thus, differentiated preoperative preparation and a rational choice of surgical interventions depending on the severity of PDS, dysfunction of the stomach and duodenum, and the degree of contamination of H. pylori made it possible to obtain good results in the near and long term after surgery.

Conclusion. Every year, peptic ulcer of the stomach and duodenum is getting younger. Significant progress has been made in the treatment of duodenal ulcer (DU). The number of surgical interventions in children for complications of duodenal ulcer is growing, from 5 to 25%.

The most common complication is pyloroduodenal stenosis, which is 65.4%.

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