Non-occlusive distal duodenal and proximal jejunal necrosis – a case report

The article presents a case of isolated, non-occlusive necrosis of the distal duodenum and proximal jejunum in an elderly patient, burdened with chronic obstructive lung disease, but without concomitant vascular or gastrointestinal disease. Diagnostic investigations included endoscopy and angio-CT. Surgery was peformed and treatment comprised resection of the necrotic parts of the duodenum and jejunum, followed by gastro-jejuno anastomosis and pyloroplasty. Post-operative course was complicated by upper gastrointestinal (GI) bleeding from multiple gastric ulcers, developed due to duodenal juice reflux into the stomach. The bleeding was successfully controlled by intensive conservative treatment with a proton pump inhibitor and somatostatin. Unfortunately, further complications developed, including urinary tract infection, respiratory failure, and sepsis, which eventually caused patient death in the intensive care unit, 2 months after the operation.