{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T23:26:05Z","timestamp":1791588365368,"version":"4.3.4"},"reference-count":32,"publisher":"MDPI AG","issue":"2","license":[{"start":{"date-parts":[[2024,1,15]],"date-time":"2024-01-15T00:00:00Z","timestamp":1705276800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>This case report underscores the importance of utilizing E-VAC (endoscopic vacuum-assisted closure) in the treatment of a perforated duodenal ulcer complicated by the formation of a subphrenic abscess and septic shock. It showcases how E-VAC can effectively mitigate the risk of further complications, such as leakage, bleeding, or rupture, which are more commonly associated with traditional methods like stents, clips, or sutures. As a result, there is a significant reduction in mortality rates. A perforated duodenal ulcer accompanied by abscess formation represents a critical medical condition that demands prompt surgical intervention. The choice of the method for abscess drainage and perforation closure plays a pivotal role in determining the patient\u2019s chances of survival. Notably, in patients with a high ASA (American Association of Anesthesiologists) score of IV-V, the mortality rate following conventional surgical intervention is considerably elevated. The management of perforated duodenal ulcers has evolved from open abdominal surgical procedures, which were associated with high mortality rates and risk of suture repair leakage, to minimally invasive techniques like laparoscopy and ingestible robots. Previously, complications arising from peptic ulcers, such as perforations, leaks, and fistulas, were primarily addressed through surgical and conservative treatments. However, over the past two decades, the medical community has shifted towards employing endoscopic closure techniques, including stents, clips, and E-VAC. E-VAC, in particular, has shown promising outcomes by promoting rapid and consistent healing. This case report presents the clinical scenario of a patient diagnosed with septic shock due to a perforated duodenal ulcer with abscess formation. Following an exploratory laparotomy that confirmed the presence of a subphrenic abscess, three drainage tubes were utilized to evacuate it. Subsequently, E-VAC therapy was initiated, with the kit being replaced three times during the recovery period. The patient exhibited favorable progress, including weight gain, and was ultimately discharged as fully recovered. In the treatment of patients with duodenal perforated ulcers and associated abscess formation, the successful and comprehensive drainage of the abscess, coupled with the closure of the perforation, emerges as a pivotal factor influencing the patient\u2019s healing process. The positive outcomes observed in these patients underscore the efficacy of employing a negative pressure E-VAC kit, resulting in thorough drainage, rapid patient recovery, and low mortality rates.<\/jats:p>","DOI":"10.3390\/jcm13020470","type":"journal-article","created":{"date-parts":[[2024,1,15]],"date-time":"2024-01-15T07:25:07Z","timestamp":1705303507000},"page":"470","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Endoscopic Vacuum-Assisted Closure (E-VAC) in Septic Shock from Perforated Duodenal Ulcers with Abscess Formations"],"prefix":"10.3390","volume":"13","author":[{"given":"Bogdan Mihnea","family":"Ciuntu","sequence":"first","affiliation":[{"name":"Department of General Surgery, Faculty of Medicine, Grigore T. Popa University of Medicine and Pharmacy, 16 Universitatii Street, 700115 Iasi, Romania"},{"name":"General Surgery Clinic, \u201cSt. Spiridon\u201d County Emergency Clinical Hospital, 1 Independence Boulevard, 700111 Iasi, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adelina","family":"Tanevski","sequence":"additional","affiliation":[{"name":"Department of General Surgery, Faculty of Medicine, Grigore T. Popa University of Medicine and Pharmacy, 16 Universitatii Street, 700115 Iasi, Romania"},{"name":"General Surgery Clinic, \u201cSt. Spiridon\u201d County Emergency Clinical Hospital, 1 Independence Boulevard, 700111 Iasi, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David Ovidiu","family":"Buescu","sequence":"additional","affiliation":[{"name":"Department of General Surgery, Faculty of Medicine, Grigore T. Popa University of Medicine and Pharmacy, 16 Universitatii Street, 700115 Iasi, Romania"},{"name":"General Surgery Clinic, \u201cSt. Spiridon\u201d County Emergency Clinical Hospital, 1 Independence Boulevard, 700111 Iasi, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Valerii","family":"Lutenco","sequence":"additional","affiliation":[{"name":"Department of General Surgery, Faculty of Medicine, \u201cDunarea de Jos\u201d University of Medicine and Pharmacy, 800010 Galati, Romania"},{"name":"General Surgery Clinic, \u201cSt. Apostol Andrei\u201d County Emergency Clinical Hospital, Strada Br\u0103ilei 177, 800578 Galati, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7081-9490","authenticated-orcid":false,"given":"Raul","family":"Mihailov","sequence":"additional","affiliation":[{"name":"Department of General Surgery, Faculty of Medicine, \u201cDunarea de Jos\u201d University of Medicine and Pharmacy, 800010 Galati, Romania"},{"name":"General Surgery Clinic, \u201cSt. Apostol Andrei\u201d County Emergency Clinical Hospital, Strada Br\u0103ilei 177, 800578 Galati, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Madalina Stefana","family":"Ciuntu","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Grigore T. Popa University of Medicine and Pharmacy, 16 Universitatii Street, 700115 Iasi, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mihai Marius","family":"Zuzu","sequence":"additional","affiliation":[{"name":"Department of General Surgery, Faculty of Medicine, Grigore T. Popa University of Medicine and Pharmacy, 16 Universitatii Street, 700115 Iasi, Romania"},{"name":"General Surgery Clinic, \u201cSt. Spiridon\u201d County Emergency Clinical Hospital, 1 Independence Boulevard, 700111 Iasi, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dan","family":"Vintila","sequence":"additional","affiliation":[{"name":"Department of General Surgery, Faculty of Medicine, Grigore T. Popa University of Medicine and Pharmacy, 16 Universitatii Street, 700115 Iasi, Romania"},{"name":"General Surgery Clinic, \u201cSt. Spiridon\u201d County Emergency Clinical Hospital, 1 Independence Boulevard, 700111 Iasi, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mihai","family":"Zabara","sequence":"additional","affiliation":[{"name":"Department of General Surgery, Faculty of Medicine, Grigore T. Popa University of Medicine and Pharmacy, 16 Universitatii Street, 700115 Iasi, Romania"},{"name":"General Surgery Clinic, \u201cSt. Spiridon\u201d County Emergency Clinical Hospital, 1 Independence Boulevard, 700111 Iasi, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ana","family":"Trofin","sequence":"additional","affiliation":[{"name":"Department of General Surgery, Faculty of Medicine, Grigore T. Popa University of Medicine and Pharmacy, 16 Universitatii Street, 700115 Iasi, Romania"},{"name":"General Surgery Clinic, \u201cSt. Spiridon\u201d County Emergency Clinical Hospital, 1 Independence Boulevard, 700111 Iasi, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ramona","family":"Cadar","sequence":"additional","affiliation":[{"name":"Department of General Surgery, Faculty of Medicine, Grigore T. Popa University of Medicine and Pharmacy, 16 Universitatii Street, 700115 Iasi, Romania"},{"name":"General Surgery Clinic, \u201cSt. Spiridon\u201d County Emergency Clinical Hospital, 1 Independence Boulevard, 700111 Iasi, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexandru","family":"Nastase","sequence":"additional","affiliation":[{"name":"Department of General Surgery, Faculty of Medicine, Grigore T. Popa University of Medicine and Pharmacy, 16 Universitatii Street, 700115 Iasi, Romania"},{"name":"General Surgery Clinic, \u201cSt. Spiridon\u201d County Emergency Clinical Hospital, 1 Independence Boulevard, 700111 Iasi, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Corina","family":"Lupascu Ursulescu","sequence":"additional","affiliation":[{"name":"Department of Radiology, Faculty of Medicine, Grigore T. Popa University of Medicine and Pharmacy, 16 Universitatii Street, 700115 Iasi, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cristian Dumitru","family":"Lupascu","sequence":"additional","affiliation":[{"name":"Department of General Surgery, Faculty of Medicine, Grigore T. 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