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Duodenal Stump Leakage

2. Introduction. Duodenal stump: the portion of the duodenum not removedLeakage is the life threatening complication of Billroth II reconstructionIncidence: 1%~4%Mortality rate: < 5% currently. 3. Billroth II Gastroenterostomy. Indications: acute perforation, massive hemorrhageProcedures:Bilateral truncal vagotomyHemigastrectomyGastrojejunostomy.

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Duodenal Stump Leakage

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    1. 1 Duodenal Stump Leakage Presented by Ri ??? Supervisor: Dr ??? 02/24/2003

    2. 2 Introduction 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

    3. 3 Billroth II Gastroenterostomy Indications: acute perforation, massive hemorrhage Procedures: Bilateral truncal vagotomy Hemigastrectomy Gastrojejunostomy

    4. 4 Figure of Billroth II

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

    6. 6 Manifestations Initial Pain High fever and shock Several days later Mild pain, fever, leukocytosis Jaundice

    7. 7 Diagnosis Echo-guided aspiration CT-guided aspiration 99mTC-labeled HIDA scan

    8. Klinicheskaia Khirurgiia, (9-10):7-8, 1997 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. The American Journal of Surgery, 162: 522-6, 1991 9 Surgical Prevention-Nissen’s closure

    10. The American Journal of Surgery, 162:522-6, 1991 10 Surgical Prevention-Bancroft’s closure

    11. 11 Surgical Prevention-Duodenostomy

    12. 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. 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. 14 Thanks for Your Attendance! Ref: 1. Maingot’s 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.

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