Pedicled Gallbladder Serosal Patch for Complex Duodenal Perforation: Technical Description and Clinical Outcome

Perforated peptic ulcers are surgical emergencies typically treated by omental patch repair. This report describes the first successful pedicled gallbladder flap for duodenal perforation repair in the setting of inadequate patch material. A previously healthy 28-year-old male was taken emergently for surgery after presenting with intra-abdominal sepsis in the setting of rapid, unintentional weight loss. Findings of feculent peritonitis and multiple colonic perforations were managed with a subtotal colectomy and temporary abdominal closure. At re-exploration, a perforated duodenal ulcer was identified. The patient's critical status and absent omentum, insufficient falciform ligament, and friable small bowel precluded traditional repair options. A pedicled gallbladder flap was fashioned instead, with the patient experiencing a successful recovery. He was discharged within a month, tolerating an oral diet and free of surgical drains. The use of a pedicled gallbladder flap to seal a duodenal perforation is a potentially viable approach rooted in existing animal models. Further research is warranted.