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Duodenal Stump Leakage

Presented by Ri Supervisor: Dr 02/24/2003


Duodenal stump: the portion of the duodenum not removed Leakage is the life threatening complication of Billroth II reconstruction Incidence: 1%~4% Mortality rate: < 5% currently

Billroth II Gastroenterostomy

Indications: acute perforation, massive hemorrhage Procedures:

Bilateral truncal vagotomy Hemigastrectomy Gastrojejunostomy

Figure of Billroth II

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
Magyar Sebeszet, 53(1):25-6, 2000 Feb 5



Pain High fever and shock Mild pain, fever, leukocytosis Jaundice

Several days later


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

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
Klinicheskaia Khirurgiia, (9-10):78, 1997 8

Surgical Prevention-Nissens closure

The American Journal of Surgery, 162: 522-6, 1991

Surgical Prevention-Bancrofts closure

The American Journal of Surgery, 162:522-6, 1991


Surgical Prevention-Duodenostomy


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


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


Thanks for Your Attendance!

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. 522~6 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.