Background: Despite the efficacy of pharmacotherapy for gastrointestinal ulcers, severe cases of bleeding or\nperforation due to gastrointestinal ulcers still occur. Giant duodenal ulcer perforation is an uncommon but difficultto-\nmanage pathology with a high mortality rate. We report two cases of giant duodenal ulcer perforation after\nneurosurgery for brainstem tumors that needed reoperation for gastric disconnection because of postoperative\nleakage and bleeding.\nCase presentation: Both cases had undergone neurosurgery for brainstem tumors, and the patients were in a\nshock state for several days with peritonitis due to giant duodenal perforation. In Case 1, antrectomy with Billroth II\nreconstruction was performed. However, reoperation for gastric disconnection was needed because of major\nleakage of gastrojejunostomy and jejunojejunostomy. In Case 2, an omental patch, cholecystectomy, and insertion\nof a bile drainage tube from the cystic duct were performed for the giant duodenal ulcer, but leakage and\nbleeding from the ulcer edge required reoperation for gastric disconnection.\nConclusions: Brainstem tumors in these cases might have been related to duodenal ulcer perforation with late\ndiagnosis that progressed to severe sepsis. For giant duodenal ulcer perforation with poor general condition, simple\nclosure including omental patch or antrectomy with reconstruction is hazardous. Antrectomy with gastric\ndisconnection, meaning gastrostomy, duodenostomy, feeding jejunostomy and cholecystectomy, is recommended
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