Comprehensive Interventional Management of Postoperative Duodenal Perforation: A Case Report
TL;DR
The feasibility of staged interventional management for postoperative duodenal perforation when reoperation is not feasible is demonstrated and a 73-year-old man who presented with hematochezia after laparoscopic distal pancreatectomy with splenectomy for pancreatic body cancer is reported.
Abstract
Duodenal perforation is an uncommon but potentially fatal complication of pancreatic surgery. We report a 73-year-old man who presented with hematochezia after laparoscopic distal pancreatectomy with splenectomy for pancreatic body cancer, complicated by a postoperative pancreatic fistula that led to gastroduodenal artery bleeding treated with a stent-graft. Contrast-enhanced CT showed active duodenal bleeding with a surrounding hematoma. The bleeding duodenal branch was embolized, and the hematoma was drained percutaneously; a fistulous communication between the periduodenal collection and the duodenal lumen was subsequently demonstrated. Through the drainage tract, an 8-Fr Foley catheter was advanced into the duodenal lumen and its balloon inflated to secure a controlled fistula, while a percutaneous gastrojejunostomy provided distal enteral feeding. The catheter was maintained for approximately 2 months, and the tract was embolized at the time of removal to minimize residual leakage. The patient recovered fully. This case demonstrates the feasibility of staged interventional management for postoperative duodenal perforation when reoperation is not feasible.