title: Duodenal stump leak following a duodenal switch: A case report.
abstract: BACKGROUND
  Duodenal switch (DS) is a superior choice for surgical weight loss in the super obese patient population. However, there is an associated risk of adverse events following a DS procedure including vitamin deficiencies, bleeding, obstruction, stricture, and leakage.
  
  
  METHODS
  A 37-year-old female with body mass index of 67kg/m(2) and multiple comorbidities underwent a Da Vinci-assisted, laparoscopic, one-stage, single-anastomosis DS procedure. On postoperative day 11, the patient developed persistent nausea, fatigue, and severe abdominal pain. She underwent diagnostic laparoscopy and was found to have hemoperitoneum, which was evacuated, but active bleeding source was not identifiable. Three days later, the patient underwent exploratory laparotomy, for bleeding with duodenal stump blowout.
  
  
  CONCLUSIONS
  Duodenal stump blowout is the result from increased pressure caused by distal obstruction with the back up of duodenal contents. Anastomotic leakage/blow-out following surgery when suspected, should be individualized and management strategy should be implemented according to the size of the leak, extent of the abscess, and status of the patient.
  
  
  CONCLUSIONS
  Duodenal stump leaks must be diagnosed as early as possible, and treated appropriately with operative intervention. Regardless of the operative technique the key to appropriate treatment is stabilize the patient, repair the duodenal stump, and adequate drainage.
authors.affiliation: Department of Bariatric Surgery, Orlando Regional Medical Center & Bariatric and Laparoscopy Center, Orlando Health, Orlando, FL, USA.
authors.forename: Lars
authors.initials: L
authors.lastname: Nelson
authors.affiliation: Department of Bariatric Surgery, Orlando Regional Medical Center & Bariatric and Laparoscopy Center, Orlando Health, Orlando, FL, USA.
authors.forename: Rena C
authors.initials: RC
authors.lastname: Moon
authors.affiliation: Department of Bariatric Surgery, Orlando Regional Medical Center & Bariatric and Laparoscopy Center, Orlando Health, Orlando, FL, USA.
authors.forename: Andre F
authors.initials: AF
authors.lastname: Teixeira
authors.affiliation: Department of Bariatric Surgery, Orlando Regional Medical Center & Bariatric and Laparoscopy Center, Orlando Health, Orlando, FL, USA. Electronic address: muhammad.jawad@orlandohealth.com.
authors.forename: Muhammad A
authors.initials: MA
authors.lastname: Jawad
keywords: Bariatric surgery; Complication; Duodenal switch; Stump leak