External Duodenal Fistula

Rossi, John A.; Sollenberger, Larry L.; Rege, Robert V.; Glenn, Jerry; Joehl, Raymond J.

doi:10.1001/archsurg.1986.01400080050009

Cited by 31 publications

(43 citation statements)

References 11 publications

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“…In fact, published studies dealing with DFS are based on small series of patients and DFS are reported after different types of surgery and for different causes (in many cases as an emergency), so the reported data are very heterogeneous and the clinical pictures are not comparable [1,2,19,[23][24][25].…”

Section: Discussionmentioning

confidence: 99%

“…According to those data, DSF incidence was about 3 %, overall mortality ranges from 7 to 67 % [2,23,24], and spontaneous fistula closure ranges from 28 to 92 % [18,23,25].…”

Section: Discussionmentioning

confidence: 99%

“…Most common reported complications were intra-abdominal abscess, wound infection, necrosis or dehiscence, diffuse peritonitis, sepsis, malnutrition, fluid and electrolytes disturbances, dermatitis, acute cholecystitis, pancreatitis, abdominal bleeding, and pneumonia [2].…”

Section: Introductionmentioning

confidence: 99%

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Duodenal stump fistula after gastric surgery for malignancies: a retrospective analysis of risk factors in a single centre experience

et al. 2014

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Background Duodenal stump fistula (DSF) is the most severe surgical complication after gastrectomy. This study was designed to assess the incidence, to observe the consequences, and to identify the risk factors associated with DSF after gastrectomy. Methods All procedures involving total or sub-total gastrectomy for cancer, performed between January 1987 and June 2012 in a single institution, were prospectively entered into a computerized database. Risk factors analysis was performed between DSF patients, patients with complete uneventful postoperative course and patients with other major surgical complications. Results Over this 25 years period, 1287 gastrectomies were performed. DSF was present in 32 cases (2.5 %). Mean post-operative onset was 6.6 days. 19 patients were treated conservatively and 13 surgically. Mean DSF healing time was 31.2 and 45.2 days in the two groups, respectively. Mortality was registered in 3 cases (9.37 %), due to septic shock (2 cases) and bleeding (1 case). In monovariate analysis, heart disease (p \ 0.001), pre-operative lymphocytes number (p = 0.003) and absence of manual reinforcement over duodenal stump (p \ 0.001) were found to be DSF-specific risk factors, whereas liver cirrhosis (p = 0.002), pre-operative albumin levels (p \ 0.001) and blood losses (p = 0.002) were found to be non-DSF-specific risk factors. In multivariate analysis heart disease (OR 5.18; p \ 0.001), liver cirrhosis (OR 13.2; p \ 0.001), bio-humoral nutritional status impairment (OR 2.29; p = 0.05), blood losses [300 mL (OR 4.47; p = 0.001) and absence of manual reinforcement over duodenal stump (OR 30.47; p \ 0.001) were found to be independent risk factors for DSF development. Conclusions Duodenal stump fistula still remains a lifethreatening complication after gastric surgery. Co-morbidity factors, nutritional status impairment and surgical technical difficulties should be considered as important risk factors in developing this awful complication.

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Section: Discussionmentioning

confidence: 99%

“…According to those data, DSF incidence was about 3 %, overall mortality ranges from 7 to 67 % [2,23,24], and spontaneous fistula closure ranges from 28 to 92 % [18,23,25].…”

Section: Discussionmentioning

confidence: 99%

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Duodenal stump fistula after gastric surgery for malignancies: a retrospective analysis of risk factors in a single centre experience

et al. 2014

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“…Although the incidence reported in the literature is low, its association with a high morbidity and mortality, as well as prolongation of hospital stay, makes it one of the surgeon's most feared postoperative problems (1).…”

Section: Introductionmentioning

confidence: 99%

Duodenal fistula after gastrectomy: Retrospective study of 13 new cases

Cornejo¹,

Priego²,

Ramos³

et al. 2015

Rev Esp Enferm Dig

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Introduction: Duodenal stump fistula (DSF) after gastrectomy has a low incidence but a high morbidity and mortality, and is therefore one of the most aggressive and feared complications of this procedure. Material and methods:We retrospectively evaluated all DSF occurred at our hospital after carrying out a gastrectomy for gastric cancer, between January 1997 and December 2014. We analyzed demographic, oncologic, and surgical variables, and the evolution in terms of morbidity, mortality and hospital stay.Results: In the period covered in this study, we performed 666 gastrectomies and observed DSF in 13 patients (1.95%). In 8 of the 13 patients (61.5%) surgery was the treatment of choice and in 5 cases (38.5%) conservative treatment was carried out.Postoperative mortality associated with DSF was 46.2% (6 cases). In the surgical group, 3 patients developed severe sepsis with multiple organ failure, 2 patients presented a major hematemesis which required endoscopic haemostasis, 1 patient had an evisceration and another presented a subphrenic abscess requiring percutaneous drainage. Six patients (75%) died despite surgery, with 3 deaths in the first 24 hours of postoperative care. The 2 patients who survived after the second surgical procedure had a hospital stay of 45 and 84 days respectively. In the conservative treatment group the cure rate was 100% with no significant complications and an average postoperative hospital stay of 39.5 days (range, 26-65 days).Conclusion: FMD is an unusual complication but it is associated with a high morbidity and mortality. In our experience, conservative management has shown better results compared with surgical treatment.

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“…Большинство НДС возникают как осложнение после оперативных вмешательств на же-лудке, двенадцатиперстной кишке (ДПК) и желчных про-токах [1,10,25,30,31]. Лечение этого патологического состояния остается трудной задачей для хирургов и зача-стую протекает на фоне тяжелого соматического статуса пациентов, сопровождается большими потерями дуоде-нального содержимого, явлениями дегидратации, маль-нутриции и сепсиса.…”

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