A novel dual-drainage system for managing a duodenal stump leak with intra-abdominal hemorrhage postgastrectomy: A case report
Abstract
Rationale: Duodenal stump leakage followed by intra-abdominal hemorrhage is a rare but serious complication of gastrectomy. Managing this condition is highly challenging. We describe a novel approach using a combined intra- and extraluminal drainage system that proved to be a simple, safe, and effective solution.
Patient concerns: A 66-year-old male with a history of hypertension and coronary artery disease presented with a 1-year history of epigastric distension and discomfort. After undergoing radical total gastrectomy for gastric adenocarcinoma, he developed increased abdominal drain output and pain, followed by acute hemorrhage from the drain site.
Diagnoses: Postoperative duodenal stump leak (diagnosed on postoperative day [POD] 6 by computed tomography scan) complicated by subsequent rupture and hemorrhage of the left hepatic artery (confirmed on POD 10 during emergency laparoscopy).
Interventions: The initial duodenal leak (POD 6) was managed with computed tomography-guided percutaneous catheter drainage. On POD 10, due to an acute intra-abdominal hemorrhage, emergency surgery was performed. After securing hemostasis of the left hepatic artery and primary suturing of the duodenal leak, a 20-French T-tube was inserted into the duodenum for intraluminal decompression. A double-cannula system was then placed adjacent to the leak site for continuous extraluminal irrigation and suction.
Outcomes: Following the procedure, the patient's condition improved steadily. The…
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