Complex duodenal fistulae: a surgical nightmare
Abstract Introduction A common feature of external duodenal fistulae is the devastating effect of the duodenal content rich in bile and pancreatic juice on nearby tissues with therapy-resistant local and systemic complications. This study analyzes the results of different management options with emp...
| Main Authors: | , , |
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| Format: | Article |
| Language: | English |
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BMC
2023-05-01
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| Series: | World Journal of Emergency Surgery |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s13017-023-00503-w |
| _version_ | 1827943505497948160 |
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| author | Ari Leppäniemi Matti Tolonen Panu Mentula |
| author_facet | Ari Leppäniemi Matti Tolonen Panu Mentula |
| author_sort | Ari Leppäniemi |
| collection | DOAJ |
| description | Abstract Introduction A common feature of external duodenal fistulae is the devastating effect of the duodenal content rich in bile and pancreatic juice on nearby tissues with therapy-resistant local and systemic complications. This study analyzes the results of different management options with emphasis on successful fistula closure rates. Methods A retrospective single academic center study of adult patients treated for complex duodenal fistulas over a 17-year period with descriptive and univariate analyses was performed. Results Fifty patients were identified. First line treatment was surgical in 38 (76%) cases and consisted of resuture or resection with anastomosis combined with duodenal decompression and periduodenal drainage in 36 cases, rectus muscle patch, and surgical decompression with T-tube in one each. Fistula closure rate was 29/38 (76%). In 12 cases, the initial management was nonoperative with or without percutaneous drainage. The fistula was closed without surgery in 5/6 patients (1 patient died with persistent fistula). Among the remaining 6 patients eventually operated, fistula closure was achieved in 4 cases. There was no difference in successful fistula closure rates among initially operatively versus nonoperatively managed patients (29/38 vs. 9/12, p = 1.000). However, when considering eventually failed nonoperative management in 7/12 patients, there was a significant difference in the fistula closure rate (29/38 vs. 5/12, p = 0.036). The overall in-hospital mortality rate was 20/50 (40%). Conclusions Surgical closure combined with duodenal decompression in complex duodenal leaks offers the best chance of successful outcome. In selected cases, nonoperative management can be tried, accepting that some patients may require surgery later. |
| first_indexed | 2024-03-13T10:16:28Z |
| format | Article |
| id | doaj.art-15bdf66a883949b38f22e588413c1f3f |
| institution | Directory Open Access Journal |
| issn | 1749-7922 |
| language | English |
| last_indexed | 2024-03-13T10:16:28Z |
| publishDate | 2023-05-01 |
| publisher | BMC |
| record_format | Article |
| series | World Journal of Emergency Surgery |
| spelling | doaj.art-15bdf66a883949b38f22e588413c1f3f2023-05-21T11:11:44ZengBMCWorld Journal of Emergency Surgery1749-79222023-05-011811610.1186/s13017-023-00503-wComplex duodenal fistulae: a surgical nightmareAri Leppäniemi0Matti Tolonen1Panu Mentula2Abdominal Center, Division of Emergency Surgery, Helsinki University Hospital, University of HelsinkiAbdominal Center, Division of Emergency Surgery, Helsinki University Hospital, University of HelsinkiAbdominal Center, Division of Emergency Surgery, Helsinki University Hospital, University of HelsinkiAbstract Introduction A common feature of external duodenal fistulae is the devastating effect of the duodenal content rich in bile and pancreatic juice on nearby tissues with therapy-resistant local and systemic complications. This study analyzes the results of different management options with emphasis on successful fistula closure rates. Methods A retrospective single academic center study of adult patients treated for complex duodenal fistulas over a 17-year period with descriptive and univariate analyses was performed. Results Fifty patients were identified. First line treatment was surgical in 38 (76%) cases and consisted of resuture or resection with anastomosis combined with duodenal decompression and periduodenal drainage in 36 cases, rectus muscle patch, and surgical decompression with T-tube in one each. Fistula closure rate was 29/38 (76%). In 12 cases, the initial management was nonoperative with or without percutaneous drainage. The fistula was closed without surgery in 5/6 patients (1 patient died with persistent fistula). Among the remaining 6 patients eventually operated, fistula closure was achieved in 4 cases. There was no difference in successful fistula closure rates among initially operatively versus nonoperatively managed patients (29/38 vs. 9/12, p = 1.000). However, when considering eventually failed nonoperative management in 7/12 patients, there was a significant difference in the fistula closure rate (29/38 vs. 5/12, p = 0.036). The overall in-hospital mortality rate was 20/50 (40%). Conclusions Surgical closure combined with duodenal decompression in complex duodenal leaks offers the best chance of successful outcome. In selected cases, nonoperative management can be tried, accepting that some patients may require surgery later.https://doi.org/10.1186/s13017-023-00503-wDuodenal leakDuodenal fistulaEnteric fistulaPostoperative peritonitisIntra-abdominal infectionDuodenal diversion |
| spellingShingle | Ari Leppäniemi Matti Tolonen Panu Mentula Complex duodenal fistulae: a surgical nightmare World Journal of Emergency Surgery Duodenal leak Duodenal fistula Enteric fistula Postoperative peritonitis Intra-abdominal infection Duodenal diversion |
| title | Complex duodenal fistulae: a surgical nightmare |
| title_full | Complex duodenal fistulae: a surgical nightmare |
| title_fullStr | Complex duodenal fistulae: a surgical nightmare |
| title_full_unstemmed | Complex duodenal fistulae: a surgical nightmare |
| title_short | Complex duodenal fistulae: a surgical nightmare |
| title_sort | complex duodenal fistulae a surgical nightmare |
| topic | Duodenal leak Duodenal fistula Enteric fistula Postoperative peritonitis Intra-abdominal infection Duodenal diversion |
| url | https://doi.org/10.1186/s13017-023-00503-w |
| work_keys_str_mv | AT arileppaniemi complexduodenalfistulaeasurgicalnightmare AT mattitolonen complexduodenalfistulaeasurgicalnightmare AT panumentula complexduodenalfistulaeasurgicalnightmare |