Duodenal Stump Leakage Research Articles

Efficacy of pre-and postvoid CT-cystograms for assessing duodenal stump leaks in patients with pancreas-kidney transplants

Efficacy of pre-and postvoid CT-cystograms for assessing duodenal stump leaks in patients with pancreas-kidney transplants

Modified Bancroft procedure for the difficult duodenal stump.

A vertical incision through the anterior wall of the antral cuff and pyloric ring permits a useful modification of the Bancroft procedure for management of the difficult duodenal stump. The approach allows completion of subtotal gastrectomy or hemigastrectomy and vagotomy for duodenal ulcer without hazarding the primary cause of morbidity and mortality in such procedures, duodenal stump leakage resulting from difficult postpyloric dissection and insecure closure. The method is recommended in selected cases.

Difficult closures of the duodenal stump.

PRIMARY closure of the duodenal stump following gastric resection for peptic ulcer disease usually poses no problem. However, when there is intense scarring or active ulceration with marked edema and inflammation, the closure and management of this difficult duodenum is of importance. Since the incidence of duodenal stump leakage is 1½% to 3%1-3and the mortality of this condition is approximately 50%,1,2,4,5every precaution should be taken to avoid this severe complication. Many different approaches have been used to manage this problem. Some prefer to avoid the difficult duodenal dissection and closure by such methods as the Devine and Bancroft antral exclusion techniques,6,7McKittrick's two-stage gastric resection,8and the sleeve resection of Wangensteen.9In many instances, however, the duodenal dissection is completed or nearly so before the difficulty of the closure can be evaluated. In this instance, several alternate methods of duodenal closure have been

The use of catheter duodenostomy in gastric resection for duodenal ulcer

Duodenal stump leakage occurs in 2 to 3 per cent of gastric resections for duodenal ulcer and is responsible for approximately 50 per cent of the mortality rate. Catheter duodenostomy has been used by an increasing number of surgeons as one method of avoiding a difficult duodenal dissection and closure. During a ten year period, catheter duodenostomy was used thirty-three times by two of us. It was employed in sixteen patients at the Los Angeles County Harbor General Hospital. In the thirty-three private patients, one death occurred from myocardial infarction; three major complications were encountered. There were seven deaths in the Harbor General Hospital; and, in our opinion, this is an indication of the more debilitated condition in this group of patients. All seven were operated upon for massive gastrointestinal hemorrhage. Catherer duodenostomy is a simple method of managing the “difficult” duodenal stump.