Percutaneous Management of Postoperative Duodenal Stump Leakage with Foley Catheter

Oh, Jeill; Lee, Hae Giu; Chun, Ho Jong; Choi, Byung Gil; Lee, Sang Hoon; Hahn, Seong Tai; Ohm, Joon Young

doi:10.1007/s00270-012-0518-6

Cited by 23 publications

(21 citation statements)

References 8 publications

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“…Mild fever associated with pain in the upper right abdomen, even many days after gastrectomy, could be indicative of DSF. Nonsurgical approaches are usually preferred [4,5], in particular percutaneous procedures such as abdominal abscess drainage, transhepatic biliary drainage with [11] or without [12] an occlusion balloon, duodenostomy [13], and fistula obliteration by glue injection [14,15], or endoscopic procedures such as DSF closure by clips [16] or endoloops and glue [17]. Nevertheless, in over one third of patients one or more reoperations are necessary.…”

Section: Discussionmentioning

confidence: 99%

Surgical management of duodenal stump fistula after elective gastrectomy for malignancy: an Italian retrospective multicenter study

et al. 2014

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Background: Duodenal stump fistula (DSF) is a severe complication of gastrectomy. Although nonsurgical therapy is preferred, surgery is still mandatory in one third of DSF patients. The aim of this article is to analyze the surgical management of DSF and factors related to its outcome. Methods: We performed a retrospective multicenter study using data from January 1990 to November 2011 in 16 Italian surgery centers. We collected 8,268 elective gastrectomies for malignancies, 7,987 by the laparotomic and 281 by the laparoscopic approach. Two hundred five patients developed a DSF, 75 of whom underwent surgery for DSF. We analyzed mortality and DSF healing time as well as the impact of clinical, oncological, and surgical characteristics. Results: The laparoscopic approach increased the risk of DSF development (odds ratio 5.6, 95 % confidence interval 2.7–10.6, P < 0.001). The indication for first DSF surgery was intra-abdominal sepsis; the failure rate was over 30 %, associated with the appearance of fistulas of neighboring organs, bleeding, and the need for reoperations. The mortality rate was 28 % and was related to the presence of vascular disease (P = 0.04), more than one reoperation (P = 0.05), sepsis (P < 0.001), and renal failure (P < 0.001). Fifty-four patients recovered after a median of 39 days (interquartile range 22–68 days); the need to perform more reoperations (P < 0.01) and the presence of an abdominal abscess (P < 0.01) led to an increase in healing time. Conclusions: Surgery for DSF has a poor prognosis. Our data will help to identify patients at risk of death, but unfortunately could not establish the best surgical procedure applicable to all cases of DSF

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Section: Discussionmentioning

confidence: 99%

Surgical management of duodenal stump fistula after elective gastrectomy for malignancy: an Italian retrospective multicenter study

et al. 2014

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“… 8 Percutaneous tube duodenostomy has been recently introduced as an effective and safe technique for the management of continuous duodenal stump leakage. 9 Tube decompression of the duodenum can initially be utilized in the management of the post-gastrectomy duodenal stump to prevent blow-out at the suture or stapler line. Thereafter, the leakage site will usually close spontaneously within 2 to 6 weeks of stoma formation.…”

Section: Introductionmentioning

confidence: 99%

Outcomes of Non-Operative Treatment for Duodenal Stump Leakage after Gastrectomy in Patients with Gastric Cancer

2016

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PurposeWe evaluated the clinical outcomes of the non-operative management of post-gastrectomy duodenal stump leakage in patients with gastric cancer.Materials and MethodsA total of 1,230 patients underwent gastrectomy at our institution between 2010 and 2014. Duodenal stump leakage was diagnosed in 19 patients (1.5%), and these patients were included in this study. The management options varied with patient condition; patients were managed conservatively, with a pigtail catheter drain, or by tube duodenostomy via a Foley catheter. The patients' clinical outcomes were analyzed.ResultsDuodenal stump leakage was diagnosed in all 19 patients within a median of 10 days (range, 1~20 days). The conservative group comprised of 5 patients (26.3%), the pigtail catheter group of 11 patients (57.9%), and the Foley catheter group of 3 patients (15.8%). All 3 management modalities were successful; none of the patients needed further operative intervention. The median hospital stay was 18, 33, and 42 days, respectively.ConclusionsNon-operative management of duodenal stump leakage for selected groups of patients with gastric cancer was effective for control of intra-abdominal sepsis. This management modality can help obviate the need for surgical intervention.

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“…In such cases, placing a Foley catheter at the stump, tube duodenostomy from the jejunum, and PTBD-OB or bile drainage via a cystic duct as an external fistula can be the only option. 18 Constructing the system of peritoneal perfusion by saline may also help to promote healing a duodenal fistula as the present case showed. Nonsurgical options such as somatostatin, nafamostat mesilate, and gabexate mesilate are naturally applicable as non-stressed supplementary treatment (Fig.…”

Section: Discussionmentioning

confidence: 67%

Repeated Duodenal Stump Perforation Using a Stapling Device Following Subtotal Gastrectomy With Roux-en-Y Reconstruction for Advanced Gastric Cancer: Lessons From a Rare Case

Furihata

Satoh³

et al. 2015

International Surgery

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Closure of the duodenal stump using a stapling device is commonly applied in Roux-en-Y reconstruction after gastrectomy. However, serious and possibly fatal duodenal stump perforation can develop in extremely rare cases. We describe a case of subtotal gastrectomy with Roux-en-Y reconstruction followed by repeated duodenal stump perforations. A 79-year-old man with a long history of diabetes and hypertension was admitted to our institution with epigastralgia and right hypochondralgia. Computed tomography and an upper gastrointestinal imaging series revealed remarkable wall thickening of the gastric antrum and corpus. Upper endoscopy also showed a giant ulcerative lesion in the same area. The lesion was confirmed by histology to be poorly differentiated adenocarcinoma. The patient underwent open subtotal gastrectomy with Roux-en-Y reconstruction. However, duodenal stump perforation occurred repeatedly on postoperative days 1, 3, and 19, which caused peritonitis. The patient was kept alive through duodenal stump repair, an additional resection using a stapling device, and repeated drainage treatments; but he suffered considerable morbidity due to these complications. We report a case of a life-threatening duodenal stump perforation after subtotal gastrectomy, highlighting lessons learned from the profile and clinical course. Abdominal surgeons should be aware of the possibility of this serious complication of duodenal stump perforation, and be able to perform immediate interventions, including life-saving reoperation.

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Percutaneous Management of Postoperative Duodenal Stump Leakage with Foley Catheter

Abstract: Fluoroscopy-guided percutaneous Foley catheter placement may be a safe and effective treatment option for postoperative duodenal stump leakage and may allow for shorter hospital stays, earlier oral intake, and more effective control of leakage sites.

Cited by 23 publications

References 8 publications

Surgical management of duodenal stump fistula after elective gastrectomy for malignancy: an Italian retrospective multicenter study

Surgical management of duodenal stump fistula after elective gastrectomy for malignancy: an Italian retrospective multicenter study

Outcomes of Non-Operative Treatment for Duodenal Stump Leakage after Gastrectomy in Patients with Gastric Cancer

Repeated Duodenal Stump Perforation Using a Stapling Device Following Subtotal Gastrectomy With Roux-en-Y Reconstruction for Advanced Gastric Cancer: Lessons From a Rare Case

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