A case report of laparoscopic omental patch repair in a patient with super-super obesity and a duodenal perforation

Introduction

We report a case of emergency laparoscopic omental patch repair in a patient with super-super obesity (body mass index of 64.7) who presented with upper gastrointestinal perforation.

Case presentation

A 52-year-old male patient with difficulty moving his body due to abdominal pain was transported to the emergency department. Contrast-enhanced computed tomography revealed duodenal bulb wall thickening and increased fat stranding in the surrounding tissue. Free air was also observed under the liver and on its surface. Therefore, diagnostic laparoscopy was performed because of a suspected upper gastrointestinal perforation.

Clinical discussion

Because the weight limit of the surgical bed was 150 kg and the width was insufficient, even when two beds were placed side-by-side, the patient's fixation on the bed was unstable, and the surgery was performed on a regular hospital bed. A 5-mm full-thickness perforation of the duodenal bulb wall was confirmed, and omental patch repair was performed. Because the bed was regular, securing the visual field without changing the patient's position was difficult. There were also limitations on the movement of the ports; therefore, seven ports were used. Postoperatively, bile-like drainage was observed from the surgical drain. However, upper gastrointestinal contrast imaging on the 14th day after the surgery revealed no contrast leakage.

Conclusion

The patient recovered well and was discharged on the 31st day after the surgery.