Sealed perforated duodenal ulcer discovered during elective laparoscopic cholecystectomy

During laparoscopic cholecystectomy (LC) there is possibility of discovering concomitant occult intra-abdominal pathology and the surgeon must be prepared to undertake the appropriate procedure. We evaluated the incidence of latent perforated duodenal ulcer in 5539 patients who underwent LC for gallstone disease at our unit between November 1991 and November 2001. Seven (0.13%) cases of perforated duodenal ulcer were discovered. Following the diagnosis of the perforation, laparoscopic suturing and omental patch repair was carried out in four patients, open repair with selective vagotomy and pyloroplasty in two patients and an open suture and omental patch repair in one patient. In all cases the cholesystectomy was completed successfully.