2022年 · 第60卷第09期

The patient, a 42-year-old male, was admitted to the hospital on November 17, 2020 due to "repeated peptic ulcer cause pending investigation". The patient had recurrent abdominal pain and acid reflux. He was diagnosed with duodenal ulcer for 4 years and was given oral acid suppressant drugs for a long time. He had 3 operations in another hospital: in September 2019, due to obvious abdominal pain and vomiting, gastroscopy showed scar-like stenosis at the descending junction of the duodenal bulb, atrophic gastritis with erosion, and performed laparoscopic distal gastrectomy + vagotomy. Postoperative pathological examination showed that the intrinsic glands in the gastric antrum decreased, a small amount of inflammatory cell infiltration, and focal lymphocyte infiltration in the gastric body; Two months after surgery, the patient had abdominal pain and vomiting again, and reexamination of gastroscopy showed anastomotic ulcer, which improved after conservative treatment; On February 10, 2020, due to severe upper abdominal pain, the emergency CT examination results showed a large amount of fluid and gas accumulation in the abdominal and pelvic cavities, and surgical exploration was performed. During the operation, a 1 cm ×1 cm rupture in the anterior wall of the great curvature of the stomach was seen, and the perforation was repaired. On September 9, 2020, due to severe epigastric pain and vomiting of coffee-colored substances, gastrointestinal perforation and upper gastrointestinal bleeding were considered, and subtotal gastrectomy was performed in the emergency department. Postoperative anastomotic stenosis and obstruction made it impossible to eat orally, and nasojejunal nutrition tube and nasogastric decompression tube were placed; One month after surgery, gastroscopy showed anastomotic ulcer and stenosis, and blood gastrin was 63 pmol/L (normal range: 2-10 pmol/L). Admission physical examination: weight 41 kg, body mass index 15.8 kg/m²。 The patient was unable to eat orally and was fed with a protein-type enteral nutrition preparation via a nasogastric nutrition tube, with a strong desire to resume oral feeding. Main diagnosis of admission: refractory peptic ulcer, anastomotic obstruction after subtotal gastrectomy, hypergastrinemia etiology to be investigated, severe malnutrition.