Outcomes of Non-Operative Treatment for Duodenal Stump Leakage after Gastrectomy in Patients with Gastric Cancer

Abstract

Purpose: We evaluated the clinical outcomes of the non-operative management of post-gastrectomy duodenal stump leakage in patients with gastric cancer.

Materials and methods: A total of 1,230 patients underwent gastrectomy at our institution between 2010 and 2014. Duodenal stump leakage was diagnosed in 19 patients (1.5%), and these patients were included in this study. The management options varied with patient condition; patients were managed conservatively, with a pigtail catheter drain, or by tube duodenostomy via a Foley catheter. The patients' clinical outcomes were analyzed.

Results: Duodenal stump leakage was diagnosed in all 19 patients within a median of 10 days (range, 1~20 days). The conservative group comprised of 5 patients (26.3%), the pigtail catheter group of 11 patients (57.9%), and the Foley catheter group of 3 patients (15.8%). All 3 management modalities were successful; none of the patients needed further operative intervention. The median hospital stay was 18, 33, and 42 days, respectively.

Conclusions: Non-operative management of duodenal stump leakage for selected groups of patients with gastric cancer was effective for control of intra-abdominal sepsis. This management modality can help obviate the need for surgical intervention.

Keywords: Duodenal stump leakage; Gastrectomy; Non-operative treatment; Stomach neoplasms; Tube duodenostomy.

Conflict of interest statement

Conflicts of Interest: No potential conflict of interest relevant to this article was reported.

Figures

Fig. 1. Abdominal computed tomography scan showing duodenal stump leakage and air pockets suggestive of abscess formation.

Fig. 2. Fluoroscopy-guided pigtail catheter insertion.

Fig. 3. Foley catheter insertion into duodenal lumen via fistula tract.