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Duodenal Stump Leakage

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Duodenal stump: the portion of the duodenum not removed ... Deep ulcer at posterior wall of duodenum. Excessive use of suture. Localized infection and sepsis ... – PowerPoint PPT presentation

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Title: 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
5
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

9
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.
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