J Gastric Cancer.  2016 Mar;16(1):28-33. 10.5230/jgc.2016.16.1.28.

Outcomes of Non-Operative Treatment for Duodenal Stump Leakage after Gastrectomy in Patients with Gastric Cancer

• Ali BI
• Park CH
• Song KY

• KMID: 2372550
• DOI: http://doi.org/10.5230/jgc.2016.16.1.28

Abstract

PURPOSE
We evaluated the clinical outcomes of the non-operative management of post-gastrectomy duodenal stump leakage in patients with gastric cancer.
MATERIALS AND METHODS
A total of 1,230 patients underwent gastrectomy at our institution between 2010 and 2014. Duodenal stump leakage was diagnosed in 19 patients (1.5%), and these patients were included in this study. The management options varied with patient condition; patients were managed conservatively, with a pigtail catheter drain, or by tube duodenostomy via a Foley catheter. The patients' clinical outcomes were analyzed.
RESULTS
Duodenal stump leakage was diagnosed in all 19 patients within a median of 10 days (range, 1~20 days). The conservative group comprised of 5 patients (26.3%), the pigtail catheter group of 11 patients (57.9%), and the Foley catheter group of 3 patients (15.8%). All 3 management modalities were successful; none of the patients needed further operative intervention. The median hospital stay was 18, 33, and 42 days, respectively.
CONCLUSIONS
Non-operative management of duodenal stump leakage for selected groups of patients with gastric cancer was effective for control of intra-abdominal sepsis. This management modality can help obviate the need for surgical intervention.

Keyword

Duodenal stump leakage; Non-operative treatment; Tube duodenostomy; Gastrectomy; Stomach neoplasms

MeSH Terms

Catheters
Duodenostomy
Gastrectomy*
Humans
Length of Stay
Sepsis
Stomach Neoplasms*

Figure

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  Fig. 1 Abdominal computed tomography scan showing duodenal stump leakage and air pockets suggestive of abscess formation.

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  Fig. 2 Fluoroscopy-guided pigtail catheter insertion.

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  Fig. 3 Foley catheter insertion into duodenal lumen via fistula tract.

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