Duodenal Stump Leakage

1
Duodenal Stump Leakage

• Presented by Ri ???
• Supervisor Dr ???
• 02/24/2003

2
Introduction

• Duodenal stump the portion of the duodenum not
  removed
• Leakage is the life threatening complication of
  Billroth II reconstruction
• Incidence 14
• Mortality rate lt 5 currently

3
Billroth II Gastroenterostomy

• Indications acute perforation, massive
  hemorrhage
• Procedures
• Bilateral truncal vagotomy
• Hemigastrectomy
• Gastrojejunostomy

4
Figure of Billroth II
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Causes of Duodenal Stump Leakage

• Deep ulcer at posterior wall of duodenum
• Excessive use of suture
• Localized infection and sepsis
• Post-operative pancreatitis
• Obstruction of the afferent loop

• Parasites infection very rare

6
Manifestations

• Initial
• Pain
• High fever and shock
• Several days later
• Mild pain, fever, leukocytosis
• Jaundice

7
Diagnosis

• Echo-guided aspiration
• CT-guided aspiration
• 99mTC-labeled HIDA scan

8
Medical Prevention

• Sandostatin long-acting analogue of somatostatin
• Decrease the excretory function of liver,
  pancreas, and stomach
• Lowering of intracavitary pressure of duodenal
  stump
• Earlier closure of fistula

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Surgical Prevention-Nissens closure
10
Surgical Prevention-Bancrofts closure
11
Surgical Prevention-Duodenostomy
12
Managements of Stump Leakage

• Closing leaks primarily is uncommon
• Goals
• Create a controlled fistula to the skin
• Prevent stimulation of biliary and pancreatic
  secretions by food/chyme passing through the
  stomach

13
Methods of Management

• Prompt and adequate closed-suction drainage of
  RUQ
• Percutaneous radiologist-guided approach
• Operative drainage
• NG tube decompression
• Feeding with jejunostomy
• Board-spectrum antibiotics

14
Thanks for Your Attendance!

• Ref
• 1. Maingots Abdominal Operations, 1997
• 2. Oxford Textbook of Surgery, 1994
• 3. Management of the Difficult Duodenal Stump,
  The American Journal of Surgery (162), P. 5226
• 4. Postoperative insufficiency of duodenal stump
  sutures caused by Ascaris lumbricoides, Magyar
  Sebeszet. 53(1)25-6, 2000 Feb.
• 5. Use of sandostatin in the prevention of suture
  failure of the duodenal stump after resection of
  the stomach, linicheskaia Khirurgiia. (9-10)7-8,
  1997.