title: Leakage of the gastroenteric anastomosis after pancreatoduodenectomy.
abstract: BACKGROUND
  Common anastomotic complications after pancreatoduodenectomy (PD) are leakage from the pancreaticojejunostomy or hepaticojejunostomy. Leakage from the gastroenteric anastomosis has rarely been described. We evaluated the incidence of gastroenteric leakage after PD and described its presentation, treatment, and outcome.
  
  
  METHODS
  Between 1992 and 2012, a consecutive series of 1,036 patients underwent PD in the Academic Medical Center. By use of a prospective database and medical records, we identified patients with gastroenteric leakage. Clinicopathologic data were compared with patients without gastroenteric leakage, and presentation, radiologic findings, treatment, and outcome of gastroenteric leaks were analyzed.
  
  
  RESULTS
  Twelve patients (1.2%) had gastroenteric leakage. Patients with gastroenteric leaks had undergone longer operative procedures, had more pancreatic fistulas and other complications, and had a significantly longer hospital stay. Median postoperative day of diagnosis was 8 (range, 2-23). Clinical signs included tender abdomen and high drain output suspicious of gastric content. Common radiologic findings were pneumoperitoneum and intra-abdominal fluid. Seven patients (58%) were treated operatively, 4 (33%) by percutaneous drainage, and 1 (8%) underwent no specific treatment duo to his poor clinical condition. This patient died in hospital, resulting in a hospital mortality of 8%.
  
  
  CONCLUSIONS
  Gastroenteric leakage after PD is rare. Clinical presentation is not specific, unlike leakage from other sites. Drain output suspicious of gastric content may help to differentiate from pancreatic or hepatic anastomotic leakage. It may be associated with a longer duration of operation and concomitant pancreatic fistula. A good outcome depends on prompt diagnosis and is mostly achieved by operative intervention.
authors.affiliation: Department of Surgery, Academic Medical Center, Amsterdam, The Netherlands. Electronic address: W.J.Eshuis@amc.uva.nl.
authors.forename: Wietse J
authors.initials: WJ
authors.lastname: Eshuis
authors.affiliation: Department of Surgery, Academic Medical Center, Amsterdam, The Netherlands.
authors.forename: Johanna A M G
authors.initials: JA
authors.lastname: Tol
authors.affiliation: Department of Radiology, Academic Medical Center, Amsterdam, The Netherlands.
authors.forename: C Yung
authors.initials: CY
authors.lastname: Nio
authors.affiliation: Department of Surgery, Academic Medical Center, Amsterdam, The Netherlands.
authors.forename: Olivier R C
authors.initials: OR
authors.lastname: Busch
authors.affiliation: Department of Surgery, Academic Medical Center, Amsterdam, The Netherlands.
authors.forename: Thomas M
authors.initials: TM
authors.lastname: van Gulik
authors.affiliation: Department of Surgery, Academic Medical Center, Amsterdam, The Netherlands.
authors.forename: Dirk J
authors.initials: DJ
authors.lastname: Gouma
mesh_terms: D000368:Aged; D057868:Anastomotic Leak / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy; D016022:Case-Control Studies; D005260:Female; D005763:Gastroenterostomy; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D016577:Pancreaticoduodenectomy; D012189:Retrospective Studies; D016896:Treatment Outcome