title: Repeated Duodenal Stump Perforation Using a Stapling Device Following Subtotal Gastrectomy With Roux-en-Y Reconstruction for Advanced Gastric Cancer: Lessons From a Rare Case.
abstract: Closure of the duodenal stump using a stapling device is commonly applied in Roux-en-Y reconstruction after gastrectomy. However, serious and possibly fatal duodenal stump perforation can develop in extremely rare cases. We describe a case of subtotal gastrectomy with Roux-en-Y reconstruction followed by repeated duodenal stump perforations. A 79-year-old man with a long history of diabetes and hypertension was admitted to our institution with epigastralgia and right hypochondralgia. Computed tomography and an upper gastrointestinal imaging series revealed remarkable wall thickening of the gastric antrum and corpus. Upper endoscopy also showed a giant ulcerative lesion in the same area. The lesion was confirmed by histology to be poorly differentiated adenocarcinoma. The patient underwent open subtotal gastrectomy with Roux-en-Y reconstruction. However, duodenal stump perforation occurred repeatedly on postoperative days 1, 3, and 19, which caused peritonitis. The patient was kept alive through duodenal stump repair, an additional resection using a stapling device, and repeated drainage treatments; but he suffered considerable morbidity due to these complications. We report a case of a life-threatening duodenal stump perforation after subtotal gastrectomy, highlighting lessons learned from the profile and clinical course. Abdominal surgeons should be aware of the possibility of this serious complication of duodenal stump perforation, and be able to perform immediate interventions, including life-saving reoperation.
authors: 1 Department of General Surgery, Kyouwa Chuo Hospital, Chikusei-shi, Ibaraki, Japan.
authors: Tadashi
authors: T
authors: Furihata
authors: Makoto
authors: M
authors: Furihata
authors: Naoki
authors: N
authors: Satoh
authors: Masato
authors: M
authors: Kosaka
authors: Kunibumi
authors: K
authors: Ishikawa
authors: Keiichi
authors: K
authors: Kubota
mesh_terms: D000368:Aged; D000713:Anastomosis, Roux-en-Y; D003952:Diagnostic Imaging; D004386:Duodenum / Q000601:surgery*; D017809:Fatal Outcome; D005743:Gastrectomy; D006801:Humans; D007416:Intestinal Perforation / Q000601:surgery*; D008297:Male; D010538:Peritonitis / Q000209:etiology; D011183:Postoperative Complications / Q000601:surgery*; D012008:Recurrence; D013274:Stomach Neoplasms / Q000601:surgery*; D017792:Surgical Stapling / Q000009:adverse effects*
keywords: Duodenal stump perforation; Gastrectomy; Gastric cancer; Roux-en-Y; Stapling device