The Blown Duodenal Stump

Abstract

Disruption of a duodenal stump closure after surgery for duodenal ulcer continues to be a disaster. Total parenteral nutrition, when added to prompt and adequate surgical drainage, has sharply reduced mortality and in many cases will eliminate the need for further operative intervention. Nonetheless, the horrendous morbidity plus the stupendous cost make this complication a catastrophe. By far the most important method for prevention of blowout of a duodenal stump is to not create one! This may seem simplistic, but it would solve the problem in the majority of cases. The concept prevails among general surgeons that an operation for duodenal ulcer is not complete unless the antrum is resected. It is true that antrectomy combined with vagotomy is an effective operation and has by far the lowest rate of ulcer recurrence of any operative procedure. It is, however, not the only operation for duodenal ulcer. Vagotomy plus a drainage