A Study on Causes and Treatment of Duodenal Stump Leakage

Year 1970, Volume: 23 Issue: 4, 1080 - 1089, 31.08.1970

Faruk Uzer

Abstract

Duodenal stump açılması, Billroth II mide rezeksiyonlarını takiben en ciddi cerrahi komplikasyonlardan biridir. 1955–1969 yılları arasında Ankara Üniversitesi I. Cerrahi Kliniğinde 1.157 mide rezeksiyonu yapılan hastadan 15’inde (% 1,3) duodenal stump açılması görüldü. Olgular lokal faktörler (kanlanma bozukluğu, travma, iltihaplı dokunun sütüre edilmesi, dren basısı, parazit hasarı), sistemik faktörler (anemi, hipoproteinemi, dehidratasyon) ve obstüktif faktörler (jejunum anslarının tıkanması, Petersen fıtığı) açısından incelendi. Açılmalar genellikle postoperatif 3–7. günlerde ani epigastrik ağrı, periton bulguları, ateş ve taşikardi ile seyretti. Mortalite oranı % 48,6 olarak hesaplandı. Tedavi seçenekleri konservatif bakım ve jejunostomi veya reoperasyon ile stump kapatılmasıydı. Erken tanı, etkili drenaj, uygun beslenme ve dikkatli cerrahi teknik başarıyı artırmaktadır.

Duodenal Stump Açılma Sebepleri ve Tedavisi Hakkında Bir Araştırma

Abstract

Duodenal stump leakage is a serious postoperative complication following Billroth II gastrectomy. Between 1955 and 1969, 1,157 patients underwent Billroth II resections at Ankara University’s First Surgical Clinic, and 15 (1.3%) developed duodenal stump leaks. We reviewed these cases alongside published series to identify etiologic factors—local (vascular compromise, traumatic handling, closure of inflamed tissue, pressure from drains, parasitic damage), systemic (anemia, hypoproteinemia, dehydration), and obstructive (jejunal limb kinking, Petersen’s hernia). Leaks typically presented on postoperative days 3–7 with sudden epigastric pain, localized peritonitis signs, fever, and tachycardia. Overall mortality was 48.6%, lower than previously reported rates (~85%). Management ranged from conservative care with jejunostomy to reoperation and stump closure. Early recognition, adequate drainage, nutritional support, and judicious surgical technique are essential to reduce morbidity and mortality.

Keywords

duodenal stump leak , Billroth II gastrectomy , postoperative peritonitis , stump closure , jejunostomy

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