From the Research
Duodenal stump insufficiency (DSI) is a serious surgical complication that occurs when there is leakage from the closed end of the duodenum after partial stomach removal, typically developing within 5-7 days after surgery and requiring prompt management to prevent severe morbidity and mortality. This condition, also known as duodenal stump leakage, is characterized by the breakdown of the suture line or staple closure of the duodenal stump, allowing digestive contents to leak into the abdominal cavity and causing severe inflammation, infection, and potentially life-threatening peritonitis 1, 2, 3.
Risk Factors and Prevention
The risk factors for duodenal stump insufficiency include technical difficulties during surgery, poor blood supply to the duodenal stump, local inflammation, malnutrition, and underlying diseases that impair wound healing such as diabetes 4, 3. Prevention strategies include meticulous surgical technique, reinforcement of the duodenal closure, and careful patient selection and optimization before surgery 5.
Management
Management of duodenal stump insufficiency typically involves prompt surgical intervention with drainage of collections, repair of the defect if possible, or creation of a controlled fistula 1, 2. Patients require intensive supportive care including intravenous antibiotics (such as piperacillin-tazobactam 4.5g IV every 8 hours or meropenem 1g IV every 8 hours), fluid resuscitation, nutritional support, and sometimes temporary parenteral nutrition 3.
Recent Advances
Recent studies have highlighted the importance of conservative management with adequate drainage, nutrition, and antibiotics in the treatment of duodenal stump leakage 3. Additionally, the use of laparoscopic single purse-string suture for reinforcement of the duodenal stump during laparoscopic radical gastrectomy has been shown to be effective in preventing duodenal stump leakage 5.
Key Considerations
The key to managing duodenal stump insufficiency is prompt recognition and intervention to prevent severe morbidity and mortality. A conservative approach with adequate drainage, nutrition, and antibiotics may be effective in some cases, while others may require surgical intervention 3. The use of reinforcement techniques such as laparoscopic single purse-string suture may help prevent duodenal stump leakage in high-risk patients 5.