Abstract
When dealing with gastric cancer with duodenal invasion, gastrectomy with distal resection of the duodenum is necessary to achieve negative distal margin. However, rupture of an ultralow duodenal stump necessitates advanced surgical skills and close postoperative observation. The present study reports a case of an early duodenal stump rupture after subtotal gastrectomy with resection of the whole first part of the duodenum, complete omentectomy, bursectomy, and D2+ lymphadenectomy performed for a pT3pN2pM1 (+ number 13 lymph nodes) adenocarcinoma of the antrum. Duodenal stump rupture was managed successfully by end tube duodenostomy, without omental patching, and tube cholangiostomy. Close assessment of clinical, physical, and radiological signs, output volume, and enzyme concentration of the tube duodenostomy, T-tube, and closed suction drain, which was placed near the tube duodenostomy site to drain the leak around the catheter, dictated postoperative management of the external duodenal fistula.
Highlights
When dealing with gastric cancer with duodenal invasion, gastrectomy with distal resection of the duodenum is necessary to achieve negative distal margin; closure of an ultralow duodenal stump may be difficult
Duodenal drainage can be obtained with either tube duodenostomy (TD) along with tube cholangiostomy (TC) or tube duodenocholangiostomy [2]
The present paper describes a case of an ultralow duodenal stump rupture after an extended gastrectomy in a patient with gastric cancer of the antrum and duodenal invasion; the rupture occurred on postoperative day 1, which is an extremely rare event
Summary
When dealing with gastric cancer with duodenal invasion, gastrectomy with distal resection of the duodenum is necessary to achieve negative distal margin; closure of an ultralow duodenal stump may be difficult. Duodenal stump closure carries a leak rate of 1–3% and a mortality rate of 0– 2% in recent series [1]. In parallel with duodenal drainage, biliary diversion, gastric diversion with Roux-en-Y reconstruction, secondary suture of the duodenal leak, usually not feasible, and close postoperative observation are paramount requirements to provide a consummate approach to duodenal stump dehiscence [3]. The present paper describes a case of an ultralow duodenal stump rupture after an extended gastrectomy in a patient with gastric cancer of the antrum and duodenal invasion; the rupture occurred on postoperative day 1, which is an extremely rare event. After ligation of the bleeding vessels, duodenal drainage was accomplished by TD and TC
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