Title: Spectrum of Presentation and Management of External Duodenal Fistula Following Surgery- A Hospital Based Study
Authors: Dr G. D. Yadav (MS, F.A.I.S., F.A.M.S.), Dr Anju Yadav (MD) , Dr Shraddha Verma (MS, M.Ch), Dr Pradeep Kumar, Dr Siddhant Singh, Dr Navendu Mohan, Dr Anand Yadav
DOI: https://dx.doi.org/10.18535/jmscr/v5i11.37
Abstract
Background: Duodenal perforation is one of the commonest causes of peptic ulcer perforation. These perforations are primarily repaired but some time they may leak post operatively and form an external duodenal fistula.
Material and Method: A total of 108 cases of external duodenal fistula were studied. The management options varied with the patient condition. Patients were either managed conservatively or underwent surgical intervention which included pyloric exclusion with gastrojejunostomy, jejunal serosal patch or Three tube methods and then the final outcome of the patients was analyzed.
Results: Out of the 108 cases of duodenal leak 82 were managed conservatively out of which 32 (39%) patients expired. The remaining 26 patients were managed by surgical intervention out of which 13 (50%) patients expired due to complications.
Conclusion: Duodenal fistula patients have an overall high mortality and poor prognosis whether managed conservatively or surgically. We found that most of the patients were managed conservatively and had positive outcome and survival. In surgical methods performed in patients requiring intervention, the pyloric exclusion with gastrojejunostomy was found to have relatively less mortality and better outcome than the other procedures used, i.e., jejunal serosal patch and Three tube method.
Keywords: Duodenal leak, pyloric exclusion with gastrojejunostomy, three tube method, jejunal serosal patch, duodenal perforation, external duodenal fistula (EDF).
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