Traumatic duodenal hematoma in the pediatric patient

Twenty children with duodenal hematomas secondary to blunt trauma were treated between 1953 and 1983. The duodenal injury was isolated in ten cases and associated with intra-abdominal injuries in the others. In ten, the duodenal injury was suspected on admission and the diagnosis was confirmed within 24 hours by radiographic contrast studies. All ten were managed successfully with nasogastric suction and intravenous fluids. Ten patients underwent laparotomy for increasing abdominal tenderness and guarding. An isolated duodenal hematoma was found in four and treated by evacuation and/or gastroenterostomy. In five of the remaining six surgical patients, all of whom had multiple intra-abdominal injuries, the duodenum was left untouched. Three of these patients had postoperative contrast studies that showed early resolution of the duodenal hematoma. No duodenal stricture or leak developed in any patient. The children with isolated duodenal hematomas who were treated conservatively had a mean hospital stay of six days, whereas those treated surgically had a mean stay of 17 days. The ten patients with multiple intra-abdominal injuries had a mean hospital stay of 32 days. In this group, eight required total parenteral nutrition or nasojejunal feeds for nutritional support. In these patients, an isolated duodenal hematoma resulted in minimal morbidity and nonoperative management was usually successful. The presence of associated intra-abdominal injuries was responsible for the prolonged hospitalization and delayed return of normal intestinal function in some patients.     

Management of ERCP-related small bowel perforations: the pivotal role of physical investigation

Background

Management of endoscopic retrograde cholangiopancreatography (ERCP)–associated duodenal perforation remains controversial. Some recommend surgery, while others recommend conservative treatment.

Methods

A retrospective chart review was conducted to identify patients treated at our institution for ERCP-related duodenal perforations. Study variables included indication for ERCP, clinical presentation, diagnostic procedures, time to diagnosis and treatment, location of injury, management, length of stay in hospital and survival.

Results

Between January 2000 and October 2009, 12 232 ERCP procedures were performed at our centre, and perforation occured in 11 patients (0.08%; 5 men, 6 women, mean age 71 yr). Six of the perforations were discovered during ERCP; 5 required radiologic imaging for diagnosis. Three perforations were diagnosed incidentally by follow-up ERCP. In 1 patient, perforation occurred 3 years after the procedure owing to a dislocated stent. Four of 11 perforations were stent-related; in 2 patients ERCP was performed in a nonanatomic situation (Billroth II gastroenterostomy). Free peritoneal perforation occurred in 4 patients; 1 was successfully managed conservatively. Four patients (36%) were treated surgically and none died. Five patients were managed conservatively with a successful outcome, and 2 patients died after conservative treatment (18%). Operative treatment included hepaticojejunostomy and duodenostomy (1 patient), suture of the perforation with T-drain (1 patient) and suture only (2 patients). The mean length of stay in hospital for all patients was 20 days.

Conclusion

Post-ERCP duodenal perforations are associated with significant morbidity and mortality. Immediate surgical evaluation and close monitoring is needed. Management should be individually tailored based on clinical findings only.     

Laparoscopic closure of perforated duodenal ulcer

Background: Medical treatment of peptic ulcer is highly successful, and the eradication of Helicobacter pylori (H. pylori) reduces ulcer recurrence. However, the incidence of perforated duodenal ulcer and its associated mortality have not been reduced by modern methods of therapy. Laparoscopic simple closure and omental plug by suturing, fibrin glue, and stapler have been successful. Methods: Over a 1-year period (1996–97), 21 patients with perforated duodenal ulcer were operated on in our hospital by laparoscopic simple closure and omental patch. The mean age was 36.4 ± 11.8 years (range, 18–61). Twenty patients were male (93.7%). The mean duration of pain was 9.1 ± 11.7 hs (range, 2–48). Three patients had a previous history of duodenal ulcer (14.3%), and another three (14.3%) patients had a history of nonsteroidal antiinflammatory drug (NSAID) intake. Erect chest radiograph showed that 19 patients had air under the diaphragm (90.5%). Sixteen patients (76.2%) had frank pus in the abdomen, and five patients had a minimal peritoneal reaction (23.8%). Results: The mean operative time was 71.6 ± 24.6 mins (range, 40–120), and the mean hospital stay was 5.2 ± 1.6 days (range, 3–9). The mean time to resume oral fluids was 3.1 ± 0.8 days (range, 2–4). Only one patient was reoperated due to leakage identified by gastrographin swallow. Conclusions: This procedure is safe and efficient; however, further study of its long-term effectiveness and comparability to existing therapy is still needed. Received: 28 May 1998/Accepted: 17 November 1998     

Laparoscopic treatment of gastroduodenal perforations: comparison with conventional surgery

Background Laparoscopic techniques have been proposed as an alternative to open surgery for the treatment of peptic ulcer perforation. This study compared the outcome of laparoscopic and open approaches for the repair of gastroduodenal perforations. Methods A retrospective review was conducted with 134 consecutive patients treated for gastroduodenal perforations. These patients included 122 with perforated duodenal ulcers, 10 with perforated gastric ulcers, and 2 with iatrogenic duodenal perforations. Whereas 68 patients were treated laparoscopically, 66 patients underwent conventional (open) surgery. Results Laparoscopic repair was successful in 65 cases (96 %). The mean operating time was shorter with the laparoscopic technique (68 vs 59 min), but the difference was not significant. The duration of postoperative nasogastric aspiration and time to resumed oral intake were shorter in the laparoscopic group (2.6 vs 4.1 days and 4.4 vs. 5.2 days, respectively; p = 0.043). The postoperative analgetic requirements, and overall complications rate were significantly lower after laparoscopic surgery (p = 0.03 and p = 0.004, respectively). There was no statistically significant difference in hospital stay (5.1 vs 6.1 days) or mortality rate between the two procedures. Conclusion Laparoscopic repair of gastroduodenal perforations is a safe alternative treatment offering certain significant short-term advantages. The preliminary results were presented at the 1st European Endoscopic Surgery Week, 15–18 June 2003, Glasgow, Scotland     

Laparoscopic suture closure of perforated duodenal peptic ulcer

The aim of this study was to assess the outcome of a continuous series of 30 patients with perforated duodenal peptic ulcers treated by a laparoscopic approach. Between January 1996 and December 1998, 30 patients (24 males, 6 females) with a mean age of 69.2 years were operated on with a laparoscopic approach. Laparoscopic treatment included peritoneal lavage, suture of the perforation, and omental patching in 24 cases. A conversion to laparotomy was necessary in five patients (16.6%). Mean operative time was 92 minutes (range: 58-114) and mean hospital stay was 6 days (range: 4-16). Mortality and morbidity rates were 6.6% (n = 2) and 16.6% (n = 5). With a median follow-up of 12 months, 96% of the patients were in good condition; one patient had recurrent duodenal ulceration. The results of our study show the feasibility of the laparoscopic approach for perforated peptic ulcer repair, with acceptable mortality and morbidity rates.     

内镜下逆行胰胆管造影并发十二指肠穿孔15例诊治分析

目的总结内镜下逆行胰胆管造影术（ERCP）并发十二指肠穿孔的临床诊治策略。方法2005年1月至2011年12月间杭州市第一人民医院共对11250例患者进行ERCP．其中15例（0．13％）出现十二指肠穿孔．对该15例患者的临床资料进行回顾性分析。结果15例患者中男性6例．女性9例．年龄45-87岁。7例为十二指肠乳头括约肌切开（EST）穿孔,5例为内镜致十二指肠壁穿孔．3例为导丝和网篮致穿透性穿孔。所有患者均有程度不一的腹痛和腹胀症状：上腹部CT提示胰周和后腹膜不同程度的积气或积液。7例穿孔在ERCP中经X线透视即获诊断：8例于术后3h至5d出现腹痛、腹胀、皮下积气和发热等症状,经腹部平片或上腹部CT明确诊断。9例患者采取内科保守治疗．其中4例在穿孔后3h内发现．采用内镜下金属钛夹封闭穿孔口加鼻胆管引流术．无腹腔脓肿发生,住院时间10-15d;5例于穿孔后10h至5d诊断,并发肠瘘2例,腹腔脓肿4例。死亡1例,住院时间15-105d。6例患者采取手术治疗,其中4例在穿孔后4-8h手术者术后无脓肿形成．住院时间18．21d：另2例分别于穿孔后24h和30h手术,术后反复腹腔出血1例．腹腔脓肿致多器官功能衰竭死亡1例。结论对于ERCP并发十二指肠穿孔。首要的是依靠术中及时发现及术后CT等检查尽早明确诊断：治疗上除传统的外科手术外．应积极采用内镜下金属钛夹、鼻胆管引流术等内镜微创治疗。     

Colonoscopic perforations: incidence, management, and outcomes

Fiberoptic colonoscopy provides superior diagnostic and therapeutic capabilities in the treatment of lower gastrointestinal disease processes. A well-recognized, but uncommon, complication during the procedure is perforation. The purpose of this study was to determine the incidence of colonoscopic perforation, define risk factors, assess the management of these complications, and evaluate outcomes. From January 1997 through December 2003, 43,609 colonoscopies were performed in our medical center. There were 14 (0.032%) perforations (1 in 3115 procedures); 7 from diagnostic and 7 from therapeutic procedures. General surgeons performed 1243 procedures (2.9%), and their rate of perforation was 0.080 per cent compared with 0.031 per cent for gastroenterologists during the same period. Half of the perforations occurred in the rectosigmoid, and the most common mechanism was mechanical (n = 6). Perforation was identified immediately during endoscopy in 50 per cent of the patients. Thirteen of 14 perforations were treated within 24 hours; 1 was delayed 48 hours. Initial surgical management was undertaken in 11/14 patients. Initial nonoperative treatment was attempted in three and was successful in only one patient. The mean length of stay following perforation was 11.2 days (range, 4-36 days). Three patients (21.4%) had 7 postoperative complications. Colonoscopic perforations are uncommon but can be recognized early and managed surgically with acceptable morbidity and postoperative length of stay.     

Pancreaticobiliary and duodenal perforations after periampullary endoscopic procedures: diagnosis and management

OBJECTIVE: To review our experience with management of pancreaticobiliary and duodenal (PB/D) perforations after periampullary endoscopic interventions. Although pancreaticobiliary and duodenal perforations after periampullary endoscopic procedures are rare, their management has not been well described. PATIENTS: Individuals who experienced pancreaticobiliary and duodenal perforations. MAIN OUTCOME MEASURES: Comorbidities, interventions performed, mechanism/site of perforation, management, and hospital morbidity/mortality. RESULTS: Seventy-five perforations (0.6%) occurred in 12,427 procedures; 20 perforations (27%) occurred during biliary stricture dilatation, 18 (24%) during diagnostic endoscopic retrograde cholangiopancreatography, and 15 (20%) during management of choledocholithiasis. Perforations were caused by guidewire insertion in 24 patients (32%), sphincterotomy in 11 (15%), passage of the endoscope in 8 (11%), or stent migration in 7 (9%) and were identified during the index procedure in 45 patients (60%). Delayed presentations included pain in 33 patients (44%), leukocytosis in 26 (35%), and/or fever in 13 (17%) and were diagnosed using computed tomography in 19 patients (25%) and abdominal radiography in 10 (13%); 9 cases (12%) were diagnosed more than 24 hours after the procedure. Indications for operative treatment were gaping duodenal perforations and perforations in patients with surgically altered anatomy. Indications for nonoperative management included contained bile duct perforations and focal duodenal perforations. Management was nonoperative in 53 patients (71%) and operative in 22 (29%). Patients with duodenal perforations, higher American Society of Anesthesia status (P<.01 each), and older age (mean +/- SEM, 65 +/- 4 vs 55 +/- 2 years; P = .02) were more likely to require operative management. Hospital stay (mean +/- SEM, 16 +/- 4 vs 4 +/- 1 days; P<.05) and mortality (13% vs 4%; P<.05) were greater in operative patients (P<.05 each). CONCLUSIONS: Most (70%) pancreaticobiliary and duodenal perforations secondary to periampullary endoscopic interventions can be managed nonoperatively. Most biliary perforations can be managed nonoperatively; a requirement for operative treatment increases the mortality rate.     

Bancroft 术在急症十二指肠溃疡穿孔中的应用

我院自1982至1992年间应用 Bancroft 术治疗急症十二指肠溃疡穿孔39例。男38例,女1例,平均年龄40岁。腹部剧痛到入院时间平均15小时,穿孔直径0.2～0.25cm。本组无手术死亡。21例(54%)随访6月至10年,无一例再发溃疡和穿孔。其疗效与择期性 Bancroft 术治疗十二指肠低位溃疡的疗效基本相同。本文讨论了本术式的适应证及术中注意事项。     

Intraoperative use of isosulfan blue in the treatment of persistent lymphatic leaks

BACKGROUND: Lymphatic leaks are a major source of morbidity after lower extremity vascular surgery. We determined the ability of isosulfan blue (Lymphazurin) use to identify and help ligate offending lymphatics, and compared postoperative complication rates and length of stay versus nonoperative therapy alone. METHODS: From January 1993 through March 2002, we identified 15 patients with lymphatic leaks. The first group consisted of 5 patients treated nonoperatively. The second group was 10 patients (11 explorations) treated operatively aided by isosulfan blue, after a trial of nonoperative therapy. RESULTS: Isosulfan blue identified the leak in 10 of 11 cases. Mean drainage time for the nonoperative group was 47.6 days versus 1.8 days for the operative group (P = 0.036). Within the operative group, the mean drainage time during their initial conservative treatment phase was 15 days versus 1.8 days after surgery (P < 0.01). Complications were significantly less in the operative group (P < 0.05). Postoperative length of stay was a mean of 4.7 days versus 8.1 days for nonoperative patients (P = not significant). CONCLUSIONS: Intraoperative isosulfan blue use accurately identifies disrupted lymphatic channels and helps ensure definitive ligation. This simple procedure is associated with fewer complications, and a trend toward shorter hospital stay.     

Results of laparoscopic treatment of perforated ulcers]

STUDY AIM: The aim of this retrospective survey was to evaluate the results of laparoscopic treatment in perforated peptic ulcer. PATIENTS AND METHODS: From 1989 to 1998, 84 patients were operated on for perforated ulcer. Sixty nine patients, operated on with videolaparoscopy, were included in this study: 53 men and 12 women with a mean age of 45 +/- 16 years (19-85). Nine had a history of peptic ulcer disease and 12 received anti-inflammatory drugs. Perforation occurred in the duodenum (60 patients) and in the stomach (five patients). Laparoscopic treatment included peritoneal lavage and either a simple duodenal closure (51 patients), a closure with a highly selective vagotomy (one patient), an epiplooplasty (eight patients), or an excision-closure for the gastric ulcers (five patients). Drainage was associated in 38 patients (58%). RESULTS: A conversion into laparotomy was necessary in six patients. Among the 59 patients treated with laparoscopy, 56 were only managed laparoscopically, three had exploration and peritoneal lavage through laparoscopy, and underwent suture of the perforation through minilaparotomy. Mean operative time was 105 +/- 40 minutes (30-240). Mean postoperative hospital stay was 8.2 +/- 4 days. Reoperation was performed in three patients for leakage (n = 2) and gall bladder perforation (n = 1). Complications were medically treated in three patients. There was no in-hospital mortality. CONCLUSION: Laparoscopic management in perforated peptic ulcer is successful in 90% of the patients. Results are good. There was no postoperative death in this series.     

Duodenal Ulcer Perforation: A District Hospital Experience

Background : Duodenal ulcer perforation still occurs frequently in the 21^st century inspite of the wide availability of proton pump inhibitors.

Method : During 2005–2008, 34 patients underwent treatment of duodenal ulcer perforation at the University Hospital Lewisham, London. Laparoscopic or open repair of the perforation was used. In this study, we analysed the outcome of treatment in terms of complications, mortality and hospital stay with relevant to laparoscopy and open approach. Results : Ten patients underwent laparoscopic closure and the remaining 24 patients underwent laparotomy. The mean hospital stay for the laparoscopic group was 6.6 days and for open repair group was 12.8 days. There were two wound infection related to open approach and four patients died during the post operative period however the cause of death was not related to the procedure.

Discussion : Laparoscopy has the advantage of avoiding a big incision and will enable the patient to get discharged home early. However, the only limiting factor is availability of expertise and competency of the surgeon.     

Intramural hematoma of the duodenum

Intramural duodenal hematoma in children is one of the least common injuries encountered. Because of the rarity of this problem, there has been little conformity of opinion as to the relative merits of operative vs nonoperative management. We reviewed 182 cases of this condition, of which 168 were taken from the English literature and 14 from our hospital. Pancreatitis was the most common associated intra-abdominal lesion (21%), while central nervous system, skeletal, and thoracic injuries (5%) accounted for the major extra-abdominal injuries. Hemophilia, von Willebrand's disease, and idiopathic thrombocytopenic purpura occurred in 7 cases and played a major role in the prognosis. Of these cases, 121 patients were treated surgically and 61 conservatively. The average hospitalization was 14 days for the surgical group and 11 days for the conservative group. There were 18 complications in the surgical group. It appears that most patients with intramural duodenal hematoma would respond well to conservative management. Surgery should be reserved for those cases that remain obstructed over seven to ten days or have evidence of perforation.     

Advances in the management of esophageal perforation

Therapy for acute esophageal perforation in the last decade has benefited from newer technology in endoscopy and imaging. Success with nonoperative therapies such as endoluminal stenting and clipping has improved outcomes and shortened length of stay in selected patients. Iatrogenic injury currently comprises most acute esophageal perforation, and nonoperative therapy may be appropriate in a significant percentage of patients. The decision regarding operative vs non-operative therapy is best done by a dedicated surgical team with experience in all the surgical and endoscopic treatment options. Boerhaave syndrome occurs less often and may be treated with endoscopic therapy, although it more likely requires operative intervention. This article reviews current advances in the diagnosis and management of acute esophageal perforation.     

Routine contrast enemas for diagnosing and managing strictures following nonoperative treatment of necrotizing enterocolitis

A study to determine the value of contrast enemas in diagnosing and managing intestinal strictures following nonoperative treatment of necrotizing enterocolitis was performed from 1978 through 1983. From 1974 through 1977, 17 patients survived nonoperative treatment of NEC and three developed symptomatic strictures, an incidence of 18% (3/17). Since then a total of 31 infants were treated for NEC; three patients survived operation for perforation and there were seven deaths, leaving 21 in the study group. Sixteen patients had contrast enemas three to six weeks after resolution of NEC, which revealed strictures in five patients. Four of the five patients with strictures demonstrated on contrast enema were without obstructive symptoms. Three of the four remained asymptomatic without treatment, and one eventually required surgery for intestinal obstruction. The fifth patient developed intestinal obstruction while still in the nursery and a contrast study demonstrated an ileal stricture. A sixth patient had a normal contrast study and developed intestinal obstruction from an ileal stricture. The incidence of strictures was 38% (6/16). In five patients, appointments for contrast studies were not kept, although clinical follow-up was complete in all. The incidence of symptomatic strictures for the contrast study period was therefore 14% (3/21). Although some authors have recommended routine contrast enemas in patients surviving nonoperative treatment of NEC, contrast enemas had no advantage over clinical follow-up in the management of patients in this study. We have discontinued the use of routine contrast enemas in favor of close follow-up and careful instruction to parents as to the early signs of intestinal obstruction.     

ERCP相关十二指肠穿孔诊治的经验和教训

目的：ERCP相关的十二指肠穿孔虽然发生率低，但死亡率很高，诊断是否及时、处理是否得当直接关系到这一严重并发症的预后。本文结合文献资料及我院的具体病例，总结与ERCP有关的十二指肠穿孔方面的经验和教训。方法：回顾我院2003年至2006年间所进行的2450例ERCP操作，有9例病人发生了十二指肠穿孔，发生率为0．37％。本文将具体分析相关的基础疾病、ERCP操作情况、穿孔的诊断、治疗手段及治疗效果。结果：7例病人经B超、MRCP或术中造影证实有胆总管结石，2例肝功能异常伴胆管扩张，怀疑胆总管结石；ERCP操作中除2例乳头插管顺利外，其余7例插管困难，运用预切开技术后6例插管成功；除3例穿孔明显的病例外，其余6例取石成功，并留置鼻胆管；穿孔的主要诊断依据为：腹膜炎2例，皮下气肿7例。3例病人进行了急诊手术，切除胆囊，胆总管切开取石后留置T管，并游离十二指肠，在后腹膜间隙放置引流；其中1例因为引流不畅，后腹腔脓肿形成而再次清创引流，平均住院50d。另外6例采用了非手术治疗，禁食，胃肠减压，鼻胆管引流，抗菌抑酶止酸；治疗过程中某些病人有局限性腹痛和发热，但无加重趋势，无病人中转治疗，平均住院13d。无死亡病例。结论：预切开技术应用不当可能导致十二指肠穿孔；皮下气肿是较为敏感的穿孔指标；如果能够早期及时诊断，非手术治疗一般能取得良好结果，建立通畅的胆道和胃肠引流是治疗成功的关键。     

The natural history of the perforated duodenal ulcer treated by suture plication.

This retrospective study of 174 patients with proven duodenal ulcer perforation was undertaken to delineate the natural history of those patients primarily managed by suture plication. During this 25-year period, 122 patients (70%) were treated with suture plication and 52 (30%) underwent a definitive procedure. There were 13 deaths in the overall group (7.4%) of which the mortality was 6.5% in the plicated group and 9.6% in the definitive group. Of the 122 patients treated with suture plication, 48% either 1) died of ulcer complications later, 2) required reoperation for ulcer disease, or 3) were under active treatment for ulcer symptoms. The reperforation rate in the entire series was 9% and the reoperation rate 32%. Suture plication is a time-honored, life-saving procedure, however, definitive surgery is a superior form of long-term management of the perforated duodenal ulcer patient.     

Small bowel obstruction in patients with a prior history of cancer.

To assess the efficacy of operative and nonoperative therapy of small bowel obstruction (SBO) in patients with a previous diagnosis of cancer, a review of 54 cases was carried out. The 32 men and 22 women had a mean age of 58 years. At presentation with SBO, 26 patients (48%) had known recurrent cancer. Forty patients were initially treated nonoperatively; 11 (28%) had resolution of their SBO after a mean of 7 days of nasogastric suction. Five of 11 patients developed recurrent SBO prior to death. Thirty-seven patients underwent laparotomy, 14 on the day of admission and 23 after failure of nasogastric suction. Twenty-five of 37 (68%) had obstruction due to recurrent carcinoma. Small bowel obstruction due to recurrent cancer occurred earlier (21 +/- 5 months) than SBO from benign causes (61 +/- 18 months; p < 0.01). Mean survival for patients with malignant obstruction (5 +/- 1 month) was significantly shorter than for those with benign obstruction (50 +/- 10 months; p < 0.001). The 30-day and in-hospital mortality rates for the 25 surgically treated patients with malignant SBO were 24% and 28%, respectively; in 9 of 25 (36%), the obstruction failed to fully resolve. The only factor predictive of in-hospital mortality was obstruction secondary to cancer (p < 0.05). The median posthospital survival for surgically treated patients with malignant SBO was only 2.5 months. We conclude that: (1) patients should be given an initial trial of nonoperative therapy; (2) patients with no known recurrence or a long interval to the development of SBO should be aggressively treated with early surgery if nonoperative treatment fails; and (3) for patients with known abdominal recurrence in whom nonoperative therapy fails, the results of surgical palliation are grim. Innovative approaches are needed to maximize palliation while also limiting morbidity and mortality.     

Posterior laparostomy through the bed of the 12th rib to drain retroperitoneal infection after endoscopic sphincterotomy

BACKGROUND: Duodenal perforation occurs in 0.4-1 per cent of endoscopic procedures. The best therapeutic approach for periampullary injury is controversial; initially the treatment is generally conservative, but sometimes large retroperitoneal infections develop that require surgery. METHODS: Six patients with an extensive retroperitoneal collection and unstable sepsis as a consequence of periampullary duodenal perforation sustained during endoscopic retrograde cholangiopancreatography were treated by right posterior laparostomy through the bed of the 12th rib. RESULTS: The sepsis was managed effectively by an open posterior approach, resulting in spontaneous closure of the duodenal leak after a mean(s.d.) of 14.5(5.2) days. No hospital death or major complication was recorded. Late incisional hernia developed in one patient. CONCLUSION: The technique of posterior laparostomy through the bed of the 12th rib provided adequate debridement and drainage of upper and lower parts of the retroperitoneal space involved by infection following periampullary duodenal perforation. Good control of retroperitoneal sepsis and duodenal secretions resulted in spontaneous closure of the duodenal leak, avoiding the need for more complex intra-abdominal procedures.     

Study on the Use of T-tube for Patients with Persistent Duodenal Fistula: Is It Useful?

Background

The commonest surgical treatment used for peptic ulcer perforation is omental patching. If, however, the perforation leaks, it rarely heals by itself due to persistence of duodenal fistula (DF). We present our experience with a T-tube placed into the DF for better outcome of the patients.

Methods

All patients in our hospital with DF following failure of surgery for duodenal perforation were included in this study. After identification of the perforation, a size 16 French T-tube was put in place. The patients were analyzed on basis of duration of hospital stay, complications related to the T-tube and overall complications, start of oral feeds, and follow-up.

Results

In this 3-year study, ten patients with DF were admitted. The mean age was 50 years. The T-tube was kept in place within the fistula for 20.5 days. The mean duration to start oral feeds was 8.8 days. The mean duration of hospital stay was 23.2 days, and the mean follow-up period was 6.3 months. The complications observed in the postoperative period were fever in four patients, wound dehiscence in four patients, and peritoneal collection in two patients, all of which were managed easily. There was no peritubal leakage and no failure of surgery as regards placement of a T-tube. There were no deaths in this study.

Conclusions

Placement of a T-tube into a DF appears to be very effective procedure for managing this complication of surgical repair of a perforated peptic ulcer with an omental patch. The technique appears to be simple and rewarding. Further use of this method by other workers will substantiate our efforts.