title: Delayed duodenal stump blow-out following total gastrectomy for cancer: Heightened awareness for the continued presence of the surgical past in the present is the key to a successful duodenal stump disruption management. A case report.
abstract: BACKGROUND
  Duodenal stump disruption remains one of the most dreadful postgastrectomy complications, posing an overwhelming therapeutic challenge.
  
  
  METHODS
  The present report describes the extremely rare occurrence of a delayed duodenal stump disruption following total gastrectomy with Roux-en-Y esophagojejunostomy for cancer, because of mechanical obstruction of the distal jejunum resulting in increased backpressure on afferent limp and duodenal stump. Surgical management included repair of distal jejunum obstruction, mobilization and re-stapling of the duodenum at the level of its intact second part and retrograde decompressing tube duodenostomy through the proximal jejunum.
  
  
  CONCLUSIONS
  Several strategies have been proposed for the successful management post-gastrectomy duodenal stump disruption however; its treatment planning is absolutely determined by the presence or not of generalized peritonitis and hemodynamic instability with hostile abdomen. In such scenario, urgent reoperation is mandatory and the damage control principle should govern the operative treatment.
  
  
  CONCLUSIONS
  Considering that scientific data about duodenal stump disruption have virtually disappeared from the current medical literature, this report by contradicting the anachronism of this complication aims to serve as a useful reminder for gastrointestinal surgeons to be familiar with the surgical techniques that provide the ability to properly manage this dreadful postoperative complication.
authors.affiliation: First Surgical Department, General Hospital Papageorgiou, West Ring Road, Nea Efkarpia, GR-56 403 Thessaloniki, Greece. Electronic address: keva@med.auth.gr.
authors.forename: K
authors.initials: K
authors.lastname: Vasiliadis
authors.affiliation: First Surgical Department, General Hospital Papageorgiou, West Ring Road, Nea Efkarpia, GR-56 403 Thessaloniki, Greece.
authors.forename: K
authors.initials: K
authors.lastname: Fortounis
authors.affiliation: First Surgical Department, General Hospital Papageorgiou, West Ring Road, Nea Efkarpia, GR-56 403 Thessaloniki, Greece.
authors.forename: A
authors.initials: A
authors.lastname: Kokarhidas
authors.affiliation: First Surgical Department, General Hospital Papageorgiou, West Ring Road, Nea Efkarpia, GR-56 403 Thessaloniki, Greece.
authors.forename: C
authors.initials: C
authors.lastname: Papavasiliou
authors.affiliation: First Surgical Department, General Hospital Papageorgiou, West Ring Road, Nea Efkarpia, GR-56 403 Thessaloniki, Greece.
authors.forename: A Al
authors.initials: AA
authors.lastname: Nimer
authors.affiliation: Department of Radiology, General Hospital Papageorgiou, West Ring Road, Nea Efkarpia, GR-56 403 Thessaloniki, Greece.
authors.forename: S
authors.initials: S
authors.lastname: Stratilati
authors.affiliation: First Surgical Department, General Hospital Papageorgiou, West Ring Road, Nea Efkarpia, GR-56 403 Thessaloniki, Greece.
authors.forename: C
authors.initials: C
authors.lastname: Makridis
keywords: Difficult duodenum; Duodenal stump blow out; Duodenal stump leakage; Gastrectomy; Tube duodenostomy