7.12. The patient is a 56-year-old male who was admitted with a...

7.12. The patient is a 56-year-old male who was admitted with a history of hematemesis for the past 36 hours. He also had some tarry black stools and was noted to have a giant gastric ulcer which was actively bleeding. Patient was subsequently referred for surgical intervention.

Final Diagnosis: 1. Acute gastric ulcer

2. Chronic pancreatitis

3. Liver cirrhosis due to alcoholism

4. Cirrhosis due to chronic hepatitis C

Procedure Performed: Subtotal gastrectomy with Billroth II anastomosis

Operative Procedure: The patient was brought to the operating room and placed on the table in a supine position, at which time general anesthesia was administered without difficulty. His abdomen was then prepped and draped in the usual sterile fashion. An upper midline incision was made. The peritoneum was then entered using the Metzenbaum scissors and hemostats. A retractor was placed, and he was noted to have a cirrhotic liver with micronodular cirrhosis. The left lobe of the liver was mobilized at that point, and the retractors were placed. On palpation of the stomach along the lesser curvature at approximately the mid portion, there was a large gastric ulcer located in the body of the stomach. At this point, the gastrocolic omentum was taken off the greater curvature of the stomach to the level just above the pylorus. Additionally, the lesser omentum was taken down off the lesser curvature of the stomach to the level of the pylorus. The body of the stomach was then transected approximately 3 cm above the ulcer. At that point, the stomach was reconstructed in a Billroth II fashion by bringing the jejunum through the transverse colon mesentery. Two stay sutures were placed to align the jejunum along the posterior wall of the stomach, and a GIA stapler was used to create the anastomosis without difficulty. The stomach and jejunum were then pulled below the transverse colon mesentery, and this was tacked in several places using 3-0 silk sutures. A feeding jejunostomy tube was then placed distal to this using the feeding jejunostomy kit without difficulty. The abdomen was then irrigated thoroughly using normal saline solution. Hemostasis was achieved using Bovie electrocautery. The midline incision was then closed using #1 PDS in a running fashion. The skin was closed using skin staples. A sterile dressing was applied. The patient was extubated in the operating room and returned to the Intensive Care Unit in guarded condition.

**10 Codes**

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