# Rare case of thrombolysis for ischemic stroke with a concurrent perforated duodenal ulcer

## TL;DR

A patient with a brain clot and a stomach ulcer received both clot-dissolving treatment and surgery, showing both can be safely used together in rare cases.

## Contribution

This is the first reported case of successful venous thrombolysis in a surgical patient with acute ischemic stroke and a perforated ulcer.

## Key findings

- The patient regained almost full motor function after treatment.
- Postoperative complications were managed conservatively without lasting effects.
- Thrombolysis and surgery were successfully combined in this rare case.

## Abstract

Acute ischemic stroke (AIS) is associated with an increased risk of mortality in surgical patients and its management is a clinical challenge. We present a case of a patient with AIS and concomitant perforated peptic ulcer, and venous thrombolysis was performed. Due to persistent abdominal pain, computed tomography was performed, showing free abdominal gas, and open surgery revealed duodenal perforation, which was corrected by excision, Mikulitz pyloroplasty, and Cellan-Jones patch. Several complications were observed in the postoperative period, which were treated conservatively, without lasting consequences. At follow-up, the patient regained almost full motor function and had no complaints regarding the repaired perforation. Venous thrombolysis is an effective treatment for AIS, but no cases have been described in surgical patients. This case represents an unconventional, simultaneous approach to the treatment of both initial conditions. Both treatment methods—thrombolysis and surgical procedure—can be successfully applied in selected cases.