DOI: http://dx.doi.org/10.18203/2349-2902.isj20205424

Management of gastrojejunostomy leakage after emergency gastrectomy

Cristina Camacho, Teresa Lindo, António Bernardes

Abstract


Ulcer perforation remains a life-threatening disease, which can be treated in several surgical approaches, however in some cases an emergency gastrectomy is the only option. Emergency gastrectomy has been associated to high morbidity and local mortality rates, namely systemic complications, such as, duodenal stump leak, gastrojejunostomy leakage and intra-abdominal collections. The treatment of gastrojejunostomy leakage, is still generating controversy, despite nowadays, the conservative approach is preferred. We present a clinical case of a 62-years-old male patient, in which a gastrojejunal leakage occurred, after emergency gastrectomy due to an ulcer perforation. Computed tomography of the abdomen did reveal peritoneal liquid near duodenal stump and gastrojejunostomy with no oral extravasation. At 24th post-operatory day, the patient deteriorated and we decided to perform a laparotomy exploration. Identified and treated, 2 small leakages (6 mm each), on the anterior face of the gastrojejunal anastomosis, using directed fistulization with Pezzer catheters. The patient was kept under total parenteral nutrition followed by enteral feeding and anti-microbial therapeutic. At the consultation, Radiography with oral contrast and Computed Tomography Scan with intravenous and oral contrast showed no evidence of anastomotic leak or abscesses, showing the success of this therapeutic approach.


Keywords


Emergency gastrectomy, Gastrojejunostomy, Leakage, Directed fistulization

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References


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