Percutaneous Transhepatic Duodenal Drainage for Failure of Duodenal Stump after Gastrectomy

Dai Maeda, Masato Fujisaki, Takayuki Takahashi, Shinobu Hirahata, Noriaki Wada, Youhei Chiba, Yoshinobu Sato, Hirosi Nakata, Takesi Nakamura and Norihiro Okamoto

Department of Surgery, Asikaga Red Cross Hospital

Leakage of the duodenal stump after total gastrectomy with Roux-en-Y anastomosis and distal gastrectomy of the Billroth II type are refractory. Conservative treatment or reoperations to drain the duodenal contents are carried out. But healing takes time and sometimes sepsis or intra-abdominal hemorrhage can complicate the healing process and even cause death. In this study we applied the technic of percutaneous transhepatic biliary drainage (PTBD) for treatment of the duodenal stump leakage in four patients. The PTBD catheter was placed into the duodenum through the liver and common bile duct to drain the duodenal contents. Octreotide acetate (Sandostatin^®) was administered in three patients in order to improve treatment outcome. This method is considered a conservative treatment of the duodenal stump leakage because it is minimally invasive and makes reoperation unnecessary. Therefore, we recommended PTBD for the treatment of duodenal stump leakage after gastrectomy. Furthermore, we think that administration of Sandostatin^R makes this treatment more effective.

Key words
leakage of the duodenal stump after gastrectomy, percutaneous transhepatic biliary drainage,
Sandostatin^R

Reprint requests
Dai Maeda Department of Surgery, Asikaga Red Cross Hospital 3-2100 Honjo, Ashikaga, 326-0808 JAPAN

Accepted
June 22, 1999

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