Alvaro F Galvez, MD1, Daniel A Galvez, MD2, Alexander Onopchenko, MD3, Nicholas J Petruzzi, MD3. 1Hahnemann University Hospital, 2Virginia Commonwealth University Health System, 3Atlanticare Regional Medical Center
We present the case of a 46-year-old male with a history of morbid obesity with an initial BMI of 44.7, who underwent an elective laparoscopic single anastomosis duodenal-ileal bypass with sleeve gastrectomy (SADI-S). Postoperatively he developed an anastomotic leak at the duodeno-ileal anastomosis that would not resolve despite reoperation. He was then converted to a Roux-en-Y gastric bypass (RYGB). Postoperative imaging failed to reveal any signs of anastomotic leak and the patient was discharged tolerating an oral diet. He returned to the emergency department 11 days later with a 6 x 3 x 2 cm sub-hepatic collection arising from the duodenal stump from the surgical conversion. Interventional radiology percutaneously drained the collection and found a connection between the cavity and the duodenum. Using this connection, a percutaneous decompressive duodenostomy drain was successfully inserted into the duodenum using a guidewire through the abscess cavity along with an extra-enteric drain placed within this cavity. The collection was obliterated and the duodenal leak was controlled successfully with percutaneous drainage, bowel rest with parenteral nutrition and broad-spectrum intravenous (IV) antibiotics. The patient was reintroduced to a bariatric clear diet after a week of bowel rest and the abscess drain was then discontinued during the same hospital admission. The patient was discharged with the percutaneous duodenostomy tube which was removed in clinic 34 days later, after the patient tolerated capping trials and imaging failed to reveal any further collections, oral contrast extravasation or distal obstruction.
In this article we analyze notable imaging from the case and review current literature on the different management options for a duodenal stump blowout. We also discuss the basics of the SADI-S procedure and conversion of a SADI-S procedure to a RYGB.
Keywords: Anastomotic leak, duodenal stump blowout, SADI-S, duodenostomy tube.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 86187
Program Number: P148
Presentation Session: iPoster Session (Non CME)
Presentation Type: Poster