Abstract

Background: Anterior Duodenal bulb perforation is a common surgical emergency, predominantly managed by operative intervention. This study aimed to evaluate the early outcomes of laparoscopic closure of anterior duodenal bulb perforation, as well as to assess prognostic factors and potential risk factors associated with this condition.

Methods: A retrospective cross-sectional descriptive study was conducted on patients who underwent laparoscopic repair of anterior duodenal bulb perforation at Nghe An Friendship General Hospital from January 2025 to December 2025.

Results: A total of 40 patients were included, with a mean age of 54.15 ± 21.19 years, of whom 77.5% were male. The most prominent risk factor was a history of nonsteroidal anti-inflammatory drug (NSAID) use (55.0%). The majority of patients had Boey scores of 0 or 1 (92.5%). Clinical findings included abdominal rigidity (95.0%) and peritoneal signs (92.5%). Pneumoperitoneum on upright abdominal radiography was observed in 95.0% of cases, while ultrasonography detected free intraperitoneal air in 100%. All perforations were located on the anterior wall of the duodenal bulb, with sizes predominantly ranging from 5-10 mm (92.5%) and a soft ulcer base in 90.0%. Subhepatic and right subcostal fluid with fibrinous exudate was present in 95.0% of patients. Closure with a single X-stitch using Vicryl 2-0 was performed in 62.5% of cases. The mean operative time was 61.9 ± 4.47 minutes. The mean time to first flatus was 2.65 ± 0.70 days, and the mean length of hospital stay was 8.03 ± 1.46 days. No cases of postoperative gastrointestinal fistula or mortality were recorded.

Conclusion: Laparoscopic management of anterior duodenal bulb perforation is a safe and effective approach, associated with a low complication rate, rapid recovery, and short hospital stay. The most common risk factor is prior NSAID use, and most patients present with low to moderate prognostic scores.