A 30 years old male presented with massive hematemesis. A 2 x 2 cm ulcer was visualized on upper GI endoscopy on the posterior aspect of first pa of duodenum. The bleeding vessel was visualized but bleeding could not be controlled endoscopically. Blood transfusion was done and patient was planned for surgery. Which of the following would be best surgical management?

**Core Concept**
The underlying principle being tested is the management of a bleeding duodenal ulcer, focusing on the surgical approach when endoscopic control fails. This involves understanding **duodenal anatomy** and the principles of surgical intervention for **upper GI bleeding**.

**Why the Correct Answer is Right**
Given the scenario where endoscopic control of bleeding from a duodenal ulcer is unsuccessful, surgical intervention is necessary. The best surgical approach in this context would typically involve a procedure that directly addresses the bleeding site, such as a **duodenotomy** to oversew the bleeding vessel, which is often the most effective way to control the hemorrhage.

**Why Each Wrong Option is Incorrect**
**Option A:** This choice is incorrect because it does not specify a procedure that directly addresses the bleeding duodenal ulcer.
**Option B:** Similarly, this option does not outline a suitable surgical approach for managing a bleeding duodenal ulcer.
**Option C:** This choice is also incorrect as it does not describe an appropriate surgical method for controlling bleeding from a duodenal ulcer.
**Option D:** Without specifying, most surgical options not involving direct oversewing of the ulcer or a similar direct approach may not be the best choice.

**Clinical Pearl / High-Yield Fact**
In cases of massive hematemesis due to a duodenal ulcer, where endoscopic methods fail to control the bleeding, surgical intervention is crucial. The key is to quickly and effectively control the bleeding source, often through direct surgical repair.

**Correct Answer:** D. Oversewing of the bleeding vessel via duodenotomy.

✓ Correct Answer: C. Duodenotomy with ligation of bleeding vessels, truncal vagotomy and pyloroplasty