Systematic treatment of giant gastroduodenal anastomotic leakage: a case report

Abstract

Background: Gastroduodenal anastomotic leakage is one of the most dreadful complications of gastrectomy and poses a great threat for treatment. However, there has been no effective treatment for it up to now. We report a case, a patient with huge gastroduodenal anastomotic leakage, was eventually recovered after conservative treatment up front and later resolution of anastomotic obstruction through gastrojejunostomy and jejunostomy.Methods and results: A 50-year-old man underwent a distal gastrectomy for a giant penetrating ulcer in the lesser curvature of the gastric sinus. Digestive reconstruction was completed by the Billroth I method. But an anastomotic leakage occurred on postoperative day 9 and a high output of duodenal juice was observed, and the following gastroscopy suggested that there was a large breach in the gastroduodenal anastomosis. Because of the patency of the drainage tube and the limitations of the patient's condition, conservative treatment was advocated and a nasojejunal tube was placed under the gastroscope for enteral nutrition. Unexpectedly, during subsequent treatment, persistent hypothermia associated with rheumatoid arthritis, drainage-associated transverse colon leakage and anastomotic stenosis occurred. Eventually, after taking the gastrojejunostomy and jejunostomy and gradually withdrawing and flushing the drainage tube, the patient was able to achieve a tube-free state and eat in the normal way.Conclusion: The course of the patient’s treatment was continuous and systematic. In this case, we found that conservative treatment was feasible for giant gastroduodenal anastomotic leakage in the presence of patent drainage and limited physical signs. And for secondary anastomotic stenosis, gastrojejunostomy can effectively relieve the obstruction.