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Treatment of Labial Fistula Communicating with the Duodenal Stump After Gastrectomy. | LitMetric

AI Article Synopsis

  • An anastomotic failure after gastroenterological surgery can lead to complications like ductal and labial fistulas, with labial fistulas being more difficult to manage.
  • A 70-year-old male patient developed a labial fistula after gastrectomy due to complications including pancreatic leakage and anastomotic failure, which was ultimately treated using intraluminal drainage with continuous suction via a rectus abdominis musculocutaneous flap.
  • The innovative approach allowed for the successful management and closure of the labial fistula, leading to the patient’s discharge after recovery.

Article Abstract

BACKGROUND Anastomotic failure after gastroenterological surgery is usually treated by intraperitoneal drainage and a mature ductal fistula. A ductal fistula may develop into a labial fistula. Although a ductal fistula is controllable, a labial fistula is intractable. We report a case of a labial fistula that communicated with the duodenal stump after gastrectomy. This condition was successfully treated by intraluminal drainage with continuous suction (IDCS) via a rectus abdominis musculocutaneous flap (RAMF). CASE REPORT A 70-year-old male underwent distal gastrectomy with intentional lymphadenectomy because of advanced gastric cancer. Digestive reconstruction was completed by the Billroth II method. Pancreatic leakage, intraperitoneal abscess, and anastomotic failure of gastrojejunostomy occurred after surgery. The duodenal stump was ruptured at postoperative day (POD) 26, and ductal fistula associated with the duodenum was observed. Unfortunately, this ductal fistula developed into a labial fistula at POD 90, and a high output of duodenal juice was observed. Additional surgery was proposed at POD 161. The broken stump and labial fistula were covered by a pedunculated RAMF, and a dual drainage system (a combination of a Penrose drain and a 2-way tube) travelled through the RAMF. The tip position of the drainage system was located in the duodenum, and the IDCS was effectively introduced. The secondary ductal fistula finally matured through the RAMF, and was subsequently closed at POD 231. The intractable labial fistula was successfully treated, and the patient was discharged at POD 235. CONCLUSIONS A high-output labial fistula, which communicated with the duodenal stump after gastrectomy, was refractory in our patient. Effective IDCS through an RAMF was useful for replacement of the labial fistula with a secondary ductal fistula.

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Source
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6590267PMC
http://dx.doi.org/10.12659/AJCR.915947DOI Listing

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