Percutaneous approach to treatment of duodenal stump leakage after Billroth II gastric resection: a clinical case and review

Abstract

Introduction: Duodenal stump leakage is a severe and life-threatening complication following gastric resection, characterized by significant morbidity and mortality. The frequency of this complication ranges between 1.6% and 5%. In recent decades, minimally invasive methods, such as percutaneous drainage, have become an effective approach.
Case Presentation: We present the case of a 62-year-old male patient who underwent a Billroth II gastric resection due to a sizeable perforated ulcer in the pyloric region. The postoperative period was relatively smooth. On the 18th day, the patient presented for a follow-up with complaints of purulent yellowish discharge from the drainage sites and subfebrile temperature. Imaging studies identified a subphrenic collection and a second smaller abdominal collection. Treatment included percutane ous drainage under combined ultrasound and radiographic guidance, followed by conservative measures. The patient recovered successfully without residual collections.
Discussion: Treating duodenal fistula presents a challenge, requiring a combination of conservative, interventional, and surgical methods. The percutaneous approach offers a minimally invasive way to manage this complication, often sufficient when combined with conservative measures. Studies indicate this approach can significantly reduce hospital stays and improve patient recovery.
Conclusion: Timely diagnosis and adequate treatment of duodenal stump insufficiency are crucial for successful patient recovery. Minimally invasive percutaneous methods are vital in managing these complications and can significantly improve outcomes.